Provider Demographics
NPI:1093113706
Name:DICKENS, DARON MARK (LMFT)
Entity Type:Individual
Prefix:
First Name:DARON
Middle Name:MARK
Last Name:DICKENS
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 WHITEHALL DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37042-5258
Mailing Address - Country:US
Mailing Address - Phone:931-614-0454
Mailing Address - Fax:
Practice Address - Street 1:116 N 2ND ST
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-3478
Practice Address - Country:US
Practice Address - Phone:931-614-0454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-11
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1139106H00000X
TX201681106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist