Provider Demographics
NPI:1811182793
Name:DICKENS, JUDITH COATES (MPA MS LPC LCAS CCS)
Entity type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:COATES
Last Name:DICKENS
Suffix:
Gender:F
Credentials:MPA MS LPC LCAS CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5405 FIELDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-4713
Mailing Address - Country:US
Mailing Address - Phone:919-610-5172
Mailing Address - Fax:919-896-7957
Practice Address - Street 1:111 WINDEL DR STE 205
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-4477
Practice Address - Country:US
Practice Address - Phone:919-610-5172
Practice Address - Fax:919-896-7957
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-13
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6867101YP2500X
NC1137101YA0400X
NC392101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6111980Medicaid