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General NPI Number Information
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NPI Number | 1568684082
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Entity Type | Individual
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Provider Name | SUELLEN M. DICKER MA, NCC, LCPC/ LPC
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Gender | Female
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 02/25/2014
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Provider Practice Location Address
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Address Line | 831 W. DELANO AVENUE
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City | PRESCOTT
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State | AZ
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Zip | 86301
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Country | US
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Telephone | 217-841-8634
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Fax |
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Provider Business Mailing Address
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Address Line | 831 W DELANO AVENUE
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City | PRESCOTT
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State | AZ
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Zip | 86301
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Country | US
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Telephone | 217-841-8634
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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 | 180-004522
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LCPC-180-004522
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC-14534
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License Number State | AZ
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