Provider Demographics
NPI:1679268270
Name:DICK, KAITLIN (LMSW)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:DICK
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4175 BUNKER HILL RD APT 5203
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75048-4510
Mailing Address - Country:US
Mailing Address - Phone:469-873-9712
Mailing Address - Fax:
Practice Address - Street 1:4175 BUNKER HILL RD APT 5203
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75048-4510
Practice Address - Country:US
Practice Address - Phone:469-873-9712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109869101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health