Provider Demographics
NPI:1417379561
Name:DYKE, FELICIA
Entity type:Individual
Prefix:DR
First Name:FELICIA
Middle Name:
Last Name:DYKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CASTLE HAVEN RD
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-6032
Mailing Address - Country:US
Mailing Address - Phone:757-469-4112
Mailing Address - Fax:757-224-3411
Practice Address - Street 1:10 CASTLE HAVEN RD
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-6032
Practice Address - Country:US
Practice Address - Phone:757-469-4112
Practice Address - Fax:757-224-3411
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-08
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2327320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities