Healthcare Provider Details

I. General information

NPI: 1417870171
Provider Name (Legal Business Name): MELINDA D FIELDS DICKSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3522 BOULEVARD STE D
COLONIAL HEIGHTS VA
23834-1304
US

IV. Provider business mailing address

P.O. BOX 14782
CHESTERFIELD VA
23832
US

V. Phone/Fax

Practice location:
  • Phone: 804-613-6068
  • Fax:
Mailing address:
  • Phone: 804-245-6280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701016339
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: