Healthcare Provider Details

I. General information

NPI: 1447989504
Provider Name (Legal Business Name): ELIZABETH DIKIBO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2022
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 BALCONES DR # 30674
AUSTIN TX
78731-4257
US

IV. Provider business mailing address

5900 BALCONES DR # 30674
AUSTIN TX
78731-4257
US

V. Phone/Fax

Practice location:
  • Phone: 214-253-9745
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number88818
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: