Healthcare Provider Details

I. General information

NPI: 1023247012
Provider Name (Legal Business Name): CRAIG ANDREW DIKE PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2009
Last Update Date: 12/05/2023
Certification Date: 12/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 CRESTWOOD PKWY NW STE 500
DULUTH GA
30096-5585
US

IV. Provider business mailing address

7400 MERTON MINTER ST 116B PSYCHOLOGY SERVICE
SAN ANTONIO TX
78229-4404
US

V. Phone/Fax

Practice location:
  • Phone: 678-924-5756
  • Fax:
Mailing address:
  • Phone: 210-617-5121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number001175
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number38905
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: