Provider Demographics
NPI:1184853921
Name:DICKINSON, MELANIE LEANN (PHD, LPC)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:LEANN
Last Name:DICKINSON
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9101 N RODNEY PARHAM RD STE B
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-1685
Mailing Address - Country:US
Mailing Address - Phone:501-389-8100
Mailing Address - Fax:
Practice Address - Street 1:9101 N RODNEY PARHAM RD STE B
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-1685
Practice Address - Country:US
Practice Address - Phone:501-389-8100
Practice Address - Fax:888-977-2956
Is Sole Proprietor?:No
Enumeration Date:2009-07-14
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP0401003101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR227569719Medicaid