Provider Demographics
NPI:1285857490
Name:DICKSHINSKI, ELINOR PHILLIPS (MS, NCC, LCPC)
Entity Type:Individual
Prefix:
First Name:ELINOR
Middle Name:PHILLIPS
Last Name:DICKSHINSKI
Suffix:
Gender:F
Credentials:MS, NCC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8834 COTTONGRASS ST
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-4943
Mailing Address - Country:US
Mailing Address - Phone:240-441-8095
Mailing Address - Fax:301-710-0175
Practice Address - Street 1:28105 THREE NOTCH RD
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20659-3235
Practice Address - Country:US
Practice Address - Phone:240-441-8095
Practice Address - Fax:301-710-0175
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC3400101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional