Healthcare Provider Details

I. General information

NPI: 1801642194
Provider Name (Legal Business Name): SKYLAR DICKEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2024
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

238 S MERIDIAN RD
YOUNGSTOWN OH
44509-2925
US

IV. Provider business mailing address

2737 YOUNGSTOWN RD SE
WARREN OH
44484-5002
US

V. Phone/Fax

Practice location:
  • Phone: 330-318-3436
  • Fax:
Mailing address:
  • Phone: 330-369-8022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA191125
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: