Provider Demographics
NPI:1235502675
Name:DICK, DEANNA (LPC)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:
Last Name:DICK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2079
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:VA
Mailing Address - Zip Code:24151-8379
Mailing Address - Country:US
Mailing Address - Phone:620-266-6133
Mailing Address - Fax:
Practice Address - Street 1:110 FRANKLIN ST STE A
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:VA
Practice Address - Zip Code:24151-1352
Practice Address - Country:US
Practice Address - Phone:540-483-0071
Practice Address - Fax:540-483-0092
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-06
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13883101YM0800X
VA0701006039101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional