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General NPI Number Information
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NPI Number | 1568073203
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Entity Type | Individual
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Provider Name | KRISTEN NOEL DICKENS PH.D., LPC, ACS, NCC
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Gender | Female
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Dates
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Enumeration Date | 08/15/2020
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Last Update Date | 08/15/2020
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Provider Practice Location Address
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Address Line | 326 MYRTLE CROSSING DR STE 200
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City | STATESBORO
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State | GA
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Zip | 30458-4689
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Country | US
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Telephone | 912-489-7590
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Fax |
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Provider Business Mailing Address
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Address Line | 401 DRIFTWOOD CT
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City | STATESBORO
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State | GA
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Zip | 30458-0279
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Country | US
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Telephone | 704-277-2806
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 011544
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License Number State | GA
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