Provider Demographics
NPI:1861038705
Name:VICK, DWIGHT POSTELL (LPC)
Entity Type:Individual
Prefix:MR
First Name:DWIGHT
Middle Name:POSTELL
Last Name:VICK
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9401 CENTREVILLE RD STE 201
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-5155
Mailing Address - Country:US
Mailing Address - Phone:703-398-0183
Mailing Address - Fax:
Practice Address - Street 1:9401 CENTREVILLE RD STE 201
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-5155
Practice Address - Country:US
Practice Address - Phone:703-398-0183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-26
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701007085101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional