Provider Demographics
NPI:1891719944
Name:DYER, PERCIVAL CHIQUITA (LPC, LMFT)
Entity Type:Individual
Prefix:MS
First Name:PERCIVAL
Middle Name:CHIQUITA
Last Name:DYER
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 308
Mailing Address - Street 2:
Mailing Address - City:BAKER,
Mailing Address - State:LA
Mailing Address - Zip Code:70704-0308
Mailing Address - Country:US
Mailing Address - Phone:866-311-7565
Mailing Address - Fax:866-311-7565
Practice Address - Street 1:371 SPRINGFIELD RD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70807
Practice Address - Country:US
Practice Address - Phone:866-311-7565
Practice Address - Fax:866-311-7565
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2120101YM0800X
TX14015101YM0800X
LA975106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist