Provider Demographics
NPI:1417275249
Name:DICKEY, WILLIAM B (MSQRPCRCLPC)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:B
Last Name:DICKEY
Suffix:
Gender:M
Credentials:MSQRPCRCLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1445 PARK SIDE EST
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-6109
Mailing Address - Country:US
Mailing Address - Phone:304-366-7698
Mailing Address - Fax:
Practice Address - Street 1:1445 PARK SIDE EST
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-6109
Practice Address - Country:US
Practice Address - Phone:304-366-7698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-04
Last Update Date:2010-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1021-1817101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)