Provider Demographics
NPI:1841754140
Name:DICKONSON, GLENDA LAURENT (PHD, LCPC)
Entity Type:Individual
Prefix:MS
First Name:GLENDA
Middle Name:LAURENT
Last Name:DICKONSON
Suffix:
Gender:F
Credentials:PHD, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7416 UPSHUR STREET
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20784-2310
Mailing Address - Country:US
Mailing Address - Phone:301-213-4519
Mailing Address - Fax:
Practice Address - Street 1:6188 OXON HILL ROAD
Practice Address - Street 2:SUITE 500
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-3136
Practice Address - Country:US
Practice Address - Phone:301-567-0400
Practice Address - Fax:301-567-0400
Is Sole Proprietor?:No
Enumeration Date:2019-01-31
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC8572101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional