| Dorene P Fick Lcsw Llc | |
|
1409 Grandin Rd Sw Roanoke VA 24015-2317 | |
| (540) 225-2835 | |
| (540) 339-7235 |
| Full Name | Dorene P Fick Lcsw Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1409 Grandin Rd Sw, Roanoke, Virginia |
| Authorized Official Name and Position | Dorene P Fick (LCSW) |
| Authorized Official Contact | 5405978512 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dorene P Fick Lcsw Llc 713 N Mill Rd Salem VA 24153-2912 Ph: (540) 597-8512 | Dorene P Fick Lcsw Llc 1409 Grandin Rd Sw Roanoke VA 24015-2317 Ph: (540) 225-2835 |
| NPI Number | 1871075978 |
|---|---|
| Provider Enumeration Date | 09/05/2018 |
| Last Update Date | 09/05/2018 |
| Medicare PECOS PAC ID | 1052659638 |
|---|---|
| Medicare Enrollment ID | O20190206000305 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871075978 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 0904006769 (Virginia) | Primary |
| Provider Name | Dorene P Fick |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1548479892 PECOS PAC ID: 5294804894 Enrollment ID: I20080522000369 |
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