Provider Demographics
NPI:1447611074
Name:DYAR, VICKI
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:
Last Name:DYAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 ROSE BUSH LN
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29909-6093
Mailing Address - Country:US
Mailing Address - Phone:760-453-1705
Mailing Address - Fax:
Practice Address - Street 1:9 ROSE BUSH LN
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29909-6093
Practice Address - Country:US
Practice Address - Phone:760-453-1705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-09
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPCC12680101YP2500X
SC8983101YP2500X
CA4750101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional