Provider Demographics
NPI:1912337254
Name:DICKENS, DARREN (LPC)
Entity Type:Individual
Prefix:
First Name:DARREN
Middle Name:
Last Name:DICKENS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1631 SHERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39440-1011
Mailing Address - Country:US
Mailing Address - Phone:601-422-3278
Mailing Address - Fax:
Practice Address - Street 1:409 W OAK ST
Practice Address - Street 2:SUITE 401A
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440-3948
Practice Address - Country:US
Practice Address - Phone:601-837-1634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-22
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1621101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional