Provider Demographics
NPI:1467896803
Name:PATRICK, DWIGHT D (LPC)
Entity Type:Individual
Prefix:MR
First Name:DWIGHT
Middle Name:D
Last Name:PATRICK
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:MR
Other - First Name:IKE
Other - Middle Name:
Other - Last Name:PATRICK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC INTERN
Mailing Address - Street 1:806 SAINT ANDREWS CT
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-5626
Mailing Address - Country:US
Mailing Address - Phone:972-372-4982
Mailing Address - Fax:972-387-3987
Practice Address - Street 1:16901 DALLAS PKWY
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-5226
Practice Address - Country:US
Practice Address - Phone:972-372-4982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-27
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70023101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX70023OtherLPC LICENSE NUMBER