Provider Demographics
NPI:1710404017
Name:DICKENS, RACHEL HALEY (PHD)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:HALEY
Last Name:DICKENS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 TIMBER CREEK DR STE 6
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-4236
Mailing Address - Country:US
Mailing Address - Phone:901-751-4430
Mailing Address - Fax:901-751-4210
Practice Address - Street 1:150 TIMBER CREEK DR STE 6
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-4236
Practice Address - Country:US
Practice Address - Phone:901-751-4430
Practice Address - Fax:901-751-4210
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3410103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily