Provider Demographics
NPI:1619730496
Name:DICKEN, JOSIAH
Entity Type:Individual
Prefix:
First Name:JOSIAH
Middle Name:
Last Name:DICKEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4545 CHAMPIONS VW APT 340
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-7394
Mailing Address - Country:US
Mailing Address - Phone:719-660-1946
Mailing Address - Fax:
Practice Address - Street 1:6545 GEMSTONE WAY
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-5535
Practice Address - Country:US
Practice Address - Phone:719-660-1946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health