Provider Demographics
NPI:1114320371
Name:DICKER, DIANA (LMFT)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:DICKER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5330 PRIMROSE DR STE 240
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-3542
Mailing Address - Country:US
Mailing Address - Phone:916-838-2293
Mailing Address - Fax:916-961-1107
Practice Address - Street 1:5330 PRIMROSE DR STE 240
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-3542
Practice Address - Country:US
Practice Address - Phone:916-838-2293
Practice Address - Fax:916-961-1107
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-02
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA80425106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA12727010OtherCAQH