Provider Demographics
NPI:1679868236
Name:DYKES, ANGELA ESSICK (LPC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:ESSICK
Last Name:DYKES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 W MONTCALM ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48838-1655
Mailing Address - Country:US
Mailing Address - Phone:616-225-1060
Mailing Address - Fax:616-225-1060
Practice Address - Street 1:721 W MONTCALM ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MI
Practice Address - Zip Code:48838-1655
Practice Address - Country:US
Practice Address - Phone:616-225-1060
Practice Address - Fax:616-225-1060
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-12
Last Update Date:2011-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401006572101YP2500X
NC7749101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional