Healthcare Provider Details

I. General information

NPI: 1679868236
Provider Name (Legal Business Name): ANGELA ESSICK DYKES LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2011
Last Update Date: 06/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 W MONTCALM ST
GREENVILLE MI
48838-1655
US

IV. Provider business mailing address

721 W MONTCALM ST
GREENVILLE MI
48838-1655
US

V. Phone/Fax

Practice location:
  • Phone: 616-225-1060
  • Fax: 616-225-1060
Mailing address:
  • Phone: 616-225-1060
  • Fax: 616-225-1060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401006572
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7749
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: