Provider Demographics
NPI:1295084846
Name:DICK, GINA LYNN (MA, LMHCA, NCACI, CD)
Entity type:Individual
Prefix:MRS
First Name:GINA
Middle Name:LYNN
Last Name:DICK
Suffix:
Gender:F
Credentials:MA, LMHCA, NCACI, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1740 NE RIDDELL RD STE 314
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-3693
Mailing Address - Country:US
Mailing Address - Phone:360-373-4077
Mailing Address - Fax:360-792-0362
Practice Address - Street 1:1740 NE RIDDELL RD STE 314
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-3693
Practice Address - Country:US
Practice Address - Phone:360-373-4077
Practice Address - Fax:360-792-0362
Is Sole Proprietor?:No
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60201203101Y00000X
WACP00006322101YA0400X
WAMC60210692101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health