Provider Demographics
NPI:1528286747
Name:DICKS, ROBERT H (LPC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:H
Last Name:DICKS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 COUNTY ROAD 989
Mailing Address - Street 2:
Mailing Address - City:IUKA
Mailing Address - State:MS
Mailing Address - Zip Code:38852-6611
Mailing Address - Country:US
Mailing Address - Phone:662-423-7422
Mailing Address - Fax:
Practice Address - Street 1:201 COUNTY ROAD 989
Practice Address - Street 2:
Practice Address - City:IUKA
Practice Address - State:MS
Practice Address - Zip Code:38852-6611
Practice Address - Country:US
Practice Address - Phone:662-423-7422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS398101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS398OtherLICENSE NUMBER