Provider Demographics
NPI:1780137885
Name:DICKENS, ELLA (MS, LPC, LCDC)
Entity type:Individual
Prefix:
First Name:ELLA
Middle Name:
Last Name:DICKENS
Suffix:
Gender:F
Credentials:MS, LPC, LCDC
Other - Prefix:
Other - First Name:MAGGIE
Other - Middle Name:
Other - Last Name:DICKENS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, LPC, LCDC
Mailing Address - Street 1:9303 PINECROFT DR
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3181
Mailing Address - Country:US
Mailing Address - Phone:713-714-1399
Mailing Address - Fax:
Practice Address - Street 1:111 VISION PARK BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77384-3003
Practice Address - Country:US
Practice Address - Phone:713-714-1399
Practice Address - Fax:713-389-5798
Is Sole Proprietor?:No
Enumeration Date:2016-07-26
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12322101YA0400X
TX70492101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)