| Doctor Name: | MR. DALE DICKER |
| NPI Number: | 1053475111 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MED LCSW |
| License Number: | 000956 |
| Business Practice Address: | 11715 Administration Dr Ste 101 St Louis, MO - 63146 |
| Business Phone Number: | 3149938123 |
| Business Fax Number: | 3149938123 |
| Mailing Address: | 11715 Administration Dr, Ste 101 ST LOUIS |
| State: | MO |
| Postal Code: | 63146 |
| Phone Number: | 3149938123 |
| Fax Number: | 3149938123 |
| NPI Enumeration Date: | 12/21/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 000956 |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | MO |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |