Healthcare Provider Details

I. General information

NPI: 1598111668
Provider Name (Legal Business Name): MICHELLE MARTINEZ DICKENS MA,LPC,NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MICHELLE DICKENS

II. Dates (important events)

Enumeration Date: 05/09/2016
Last Update Date: 10/17/2025
Certification Date: 10/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2235 POYDRAS ST STE A
NEW ORLEANS LA
70119-7561
US

IV. Provider business mailing address

4700 WICHERS DR STE 304
MARRERO LA
70072-3054
US

V. Phone/Fax

Practice location:
  • Phone: 504-814-8001
  • Fax: 504-814-8002
Mailing address:
  • Phone: 504-309-3262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC10325
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6583
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: