Healthcare Provider Details

I. General information

NPI: 1093703266
Provider Name (Legal Business Name): GREGORY DICKINSON PCC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2675 OAKWOOD DR
CUYAHOGA FALLS OH
44221-2648
US

IV. Provider business mailing address

2675 OAKWOOD DR
CUYAHOGA FALLS OH
44221-2648
US

V. Phone/Fax

Practice location:
  • Phone: 330-940-2522
  • Fax: 330-940-3366
Mailing address:
  • Phone: 330-940-2522
  • Fax: 330-940-3366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE-0003724
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: