Provider Demographics
NPI:1922616986
Name:DICKENS, CAROLYN MONIQUE
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:MONIQUE
Last Name:DICKENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 BATTLEFIELD BLVD N UNIT 1942
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23327-1288
Mailing Address - Country:US
Mailing Address - Phone:757-575-4585
Mailing Address - Fax:
Practice Address - Street 1:657 RIDGE CIR
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-4866
Practice Address - Country:US
Practice Address - Phone:757-575-4585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-16
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health