Healthcare Provider Details

I. General information

NPI: 1700335049
Provider Name (Legal Business Name): HOLLY ANN DICKINSON LLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2016
Last Update Date: 09/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1029 WOODBINE AVE
LANSING MI
48910-2770
US

IV. Provider business mailing address

1029 WOODBINE AVE
LANSING MI
48910-2770
US

V. Phone/Fax

Practice location:
  • Phone: 517-214-5551
  • Fax:
Mailing address:
  • Phone: 517-214-5551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401015594
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: