Healthcare Provider Details

I. General information

NPI: 1548479892
Provider Name (Legal Business Name): DORENE P. FICK LCSW-R
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 10/13/2022
Certification Date: 10/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1409 GRANDIN RD SW
ROANOKE VA
24015-2317
US

IV. Provider business mailing address

713 N MILL RD
SALEM VA
24153-2912
US

V. Phone/Fax

Practice location:
  • Phone: 540-225-2835
  • Fax: 540-339-7235
Mailing address:
  • Phone: 540-389-5657
  • Fax: 540-772-5157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number056891-R
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number090406769
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: