Provider Demographics
NPI:1376846915
Name:DICKIE, KRISTIN D (LPC)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:D
Last Name:DICKIE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3303 LATROBE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-4851
Mailing Address - Country:US
Mailing Address - Phone:704-362-2663
Mailing Address - Fax:704-362-2836
Practice Address - Street 1:3303 LATROBE DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-4851
Practice Address - Country:US
Practice Address - Phone:704-362-2663
Practice Address - Fax:704-362-2836
Is Sole Proprietor?:No
Enumeration Date:2010-12-20
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7649101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)