Provider Demographics
NPI:1871075978
Name:DORENE P FICK LCSW LLC
Entity type:Organization
Organization Name:DORENE P FICK LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:MS
Authorized Official - First Name:DORENE
Authorized Official - Middle Name:P
Authorized Official - Last Name:FICK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:540-597-8512
Mailing Address - Street 1:713 N MILL RD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-2912
Mailing Address - Country:US
Mailing Address - Phone:540-597-8512
Mailing Address - Fax:540-337-7235
Practice Address - Street 1:1409 GRANDIN RD SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24015-2317
Practice Address - Country:US
Practice Address - Phone:540-225-2835
Practice Address - Fax:540-339-7235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904006769261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)