Provider Demographics
NPI:1710175351
Name:CICCARELLI, DIXIE F (MACE, MAPC, LPC, ATR)
Entity Type:Individual
Prefix:MRS
First Name:DIXIE
Middle Name:F
Last Name:CICCARELLI
Suffix:
Gender:F
Credentials:MACE, MAPC, LPC, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4202 E SHEENA DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-5809
Mailing Address - Country:US
Mailing Address - Phone:602-397-8280
Mailing Address - Fax:602-249-8103
Practice Address - Street 1:4202 E SHEENA DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-5809
Practice Address - Country:US
Practice Address - Phone:602-397-8280
Practice Address - Fax:602-249-8103
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC13639101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor