Provider Demographics
NPI:1568684082
Name:DICKER, SUELLEN M (MA, NCC, LCPC/ LPC)
Entity Type:Individual
Prefix:MRS
First Name:SUELLEN
Middle Name:M
Last Name:DICKER
Suffix:
Gender:F
Credentials:MA, NCC, LCPC/ LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:831 W DELANO AVENUE
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301
Mailing Address - Country:US
Mailing Address - Phone:217-841-8634
Mailing Address - Fax:
Practice Address - Street 1:831 W. DELANO AVENUE
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301
Practice Address - Country:US
Practice Address - Phone:217-841-8634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-004522101YP2500X
ILLCPC-180-004522101YP2500X
AZLPC-14534101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional