Provider Demographics
NPI:1215306287
Name:DICKENS, DENISE (PLPC)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:DICKENS
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1824 JADEN CT
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:MO
Mailing Address - Zip Code:65536-4107
Mailing Address - Country:US
Mailing Address - Phone:417-718-9065
Mailing Address - Fax:
Practice Address - Street 1:704 HISTORIC 66 W STE 207
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:MO
Practice Address - Zip Code:65583-2136
Practice Address - Country:US
Practice Address - Phone:573-433-4846
Practice Address - Fax:573-433-1208
Is Sole Proprietor?:No
Enumeration Date:2015-09-21
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015030972101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor