=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982706537
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TAMALA KAY DICKEY LMSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/03/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3600 S DORT HWY SUITE 46
-----------------------------------------------------
City | FLINT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-767-0350
-----------------------------------------------------
Fax | 810-767-4031
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 508 FREMONT ST
-----------------------------------------------------
City | FLINT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-768-0021
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | 6801087381
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------