Healthcare Provider Details

I. General information

NPI: 1750508503
Provider Name (Legal Business Name): THOMAS DIKEL PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 SW 7 TERRACE
GAINESVILLE FL
32601
US

IV. Provider business mailing address

225 SW 7 TERRACE
GAINESVILLE FL
32608
US

V. Phone/Fax

Practice location:
  • Phone: 352-379-2829
  • Fax: 352-379-2843
Mailing address:
  • Phone: 352-379-2829
  • Fax: 352-379-2843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPY6256
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: