Provider Demographics
NPI:1225389737
Name:DICKENS, AMANDA NICOLE (MS, LPC)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:NICOLE
Last Name:DICKENS
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:NICOLE
Other - Last Name:JOYNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LPC
Mailing Address - Street 1:5643 SANDHILL DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27105-9707
Mailing Address - Country:US
Mailing Address - Phone:252-904-3760
Mailing Address - Fax:
Practice Address - Street 1:100 S MARSHALL ST
Practice Address - Street 2:SUITE 1
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-2843
Practice Address - Country:US
Practice Address - Phone:252-904-3760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-24
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8444101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health