MEDICARE: ELINOR PHILLIPS DICKSHINSKI M.S., NCC, L.C.P.C

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	101YP2500X	Professional Counselor	LC3400	MD

General Provider Information

NPI Number	:	1285857490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELINOR PHILLIPS DICKSHINSKI M.S., NCC, L.C.P.C

Provider Business Mailing Address
First Line	:	8834 COTTONGRASS ST
Second Line	:
City	:	WALDORF
State	:	MD
Zip	:	20603-4943
Country	:	US
Telephone Number	:	240-441-8095
Fax Number	:	301-710-0175

Provider Business Practice Location Address
First Line	:	28105 THREE NOTCH RD
Second Line	:
City	:	MECHANICSVILLE
State	:	MD
Zip	:	20659-3235
Country	:	US
Telephone Number	:	240-441-8095
Fax Number	:	301-710-0175

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

Provider Enumeration Date	:	04/10/2007
Last Update Date	:	03/10/2015

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