MEDICARE: DEANNA DICK LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	13883	NC
2	101YP2500X	Professional Counselor	0701006039	VA
3	101YM0800X	Mental Health Counselor	0701006039	VA

General Provider Information

NPI Number	:	1235502675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEANNA DICK LPC

Provider Business Mailing Address
First Line	:	PO BOX 2079
Second Line	:
City	:	ROCKY MOUNT
State	:	VA
Zip	:	24151-8379
Country	:	US
Telephone Number	:	620-266-6133
Fax Number	:

Provider Business Practice Location Address
First Line	:	5 E COURT ST STE 301
Second Line	:
City	:	ROCKY MOUNT
State	:	VA
Zip	:	24151-1761
Country	:	US
Telephone Number	:	540-483-0071
Fax Number	:	540-483-0092

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2015
Last Update Date	:	05/02/2025

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