Provider Demographics
NPI:1497469993
Name:CANDACE DICKINSON COUNSELING SERVICES LLC CANDACE DICKINSON SOLE MBR
Entity Type:Organization
Organization Name:CANDACE DICKINSON COUNSELING SERVICES LLC CANDACE DICKINSON SOLE MBR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:
Authorized Official - Last Name:DICKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMHC
Authorized Official - Phone:508-571-8757
Mailing Address - Street 1:100 POWDERMILL RD # 209
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-5932
Mailing Address - Country:US
Mailing Address - Phone:508-571-8757
Mailing Address - Fax:
Practice Address - Street 1:100 CUMMINGS CTR STE 342H
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6500
Practice Address - Country:US
Practice Address - Phone:508-571-8757
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-09
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health