Doctor Name: | MR. LARRY SCOTT DICKSON |
NPI Number: | 1114025467 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MA |
License Number: | PC004060 |
Business Practice Address: | 18201 Conneaut Lake Rd Meadville, PA - 163353757 |
Business Phone Number: | 8143335061 |
Business Fax Number: | 8143335067 |
Mailing Address: | 20829 Highway 6 And 19, SAEGERTOWN |
State: | PA |
Postal Code: | 164334145 |
Phone Number: | 8143988455 |
Fax Number: | |
NPI Enumeration Date: | 09/20/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | PC004060 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |