Provider Demographics
NPI:1588796718
Name:DICKINSON, ANNE JEANINE (PSYD, LCPC, CADC)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:JEANINE
Last Name:DICKINSON
Suffix:
Gender:F
Credentials:PSYD, LCPC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1098 KILBERY LN
Mailing Address - Street 2:
Mailing Address - City:NORTH AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60542-4613
Mailing Address - Country:US
Mailing Address - Phone:708-207-8381
Mailing Address - Fax:630-416-8306
Practice Address - Street 1:1560 WALL ST
Practice Address - Street 2:SUITE 304
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-1123
Practice Address - Country:US
Practice Address - Phone:708-207-8381
Practice Address - Fax:630-416-8306
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL17874101YA0400X
IL180006302101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)