Healthcare Provider Details

I. General information

NPI: 1326260670
Provider Name (Legal Business Name): DENISE ANNE DICKEY L.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DENISE ANDES

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 RIDGECREST DRIVE
SANTA FE NM
87505
US

IV. Provider business mailing address

138 RIDGECREST DRIVE
SANTA FE NM
87505
US

V. Phone/Fax

Practice location:
  • Phone: 505-438-9592
  • Fax: 505-438-9592
Mailing address:
  • Phone: 505-438-9592
  • Fax: 505-438-9592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0929
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: