Provider Demographics
NPI:1639662166
Name:DICKOW, ROBERT PETER (LPC, LLP)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:PETER
Last Name:DICKOW
Suffix:
Gender:M
Credentials:LPC, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5705 LAKE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-7760
Mailing Address - Country:US
Mailing Address - Phone:810-986-6301
Mailing Address - Fax:
Practice Address - Street 1:5705 LAKE RIDGE DR
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-7760
Practice Address - Country:US
Practice Address - Phone:810-986-6301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-09
Last Update Date:2018-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401005067101YP2500X
MI6301000686103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional