MEDICARE: DR. LAURA DIMMICK PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	0810004922	VA

General Provider Information

NPI Number	:	1649696113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAURA DIMMICK PSY.D.

Provider Business Mailing Address
First Line	:	2519 GROVE AVE
Second Line	:	APARTMENT 2
City	:	RICHMOND
State	:	VA
Zip	:	23220-4417
Country	:	US
Telephone Number	:	305-776-7635
Fax Number	:

Provider Business Practice Location Address
First Line	:	703 N COURTHOUSE RD
Second Line	:	SUITE 101
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23236-4069
Country	:	US
Telephone Number	:	804-794-4482
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2014
Last Update Date	:	03/11/2014

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