Provider Demographics
NPI:1790981454
Name:DIMMICK, MARIE N (MFC)
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:N
Last Name:DIMMICK
Suffix:
Gender:F
Credentials:MFC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 HEMSTED DR
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-0934
Mailing Address - Country:US
Mailing Address - Phone:530-223-4794
Mailing Address - Fax:530-222-8892
Practice Address - Street 1:280 HEMSTED DR
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-0934
Practice Address - Country:US
Practice Address - Phone:530-223-4794
Practice Address - Fax:530-222-8892
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40239106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist