Provider Demographics
NPI:1144641424
Name:DICK, HAROLD JR
Entity type:Individual
Prefix:
First Name:HAROLD
Middle Name:
Last Name:DICK
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 103
Mailing Address - Street 2:
Mailing Address - City:HOONAH
Mailing Address - State:AK
Mailing Address - Zip Code:99829-0103
Mailing Address - Country:US
Mailing Address - Phone:907-945-3517
Mailing Address - Fax:907-945-3239
Practice Address - Street 1:568 RAVEN DRIVE
Practice Address - Street 2:
Practice Address - City:HOONAH
Practice Address - State:AK
Practice Address - Zip Code:99829-0103
Practice Address - Country:US
Practice Address - Phone:907-945-3517
Practice Address - Fax:907-945-3239
Is Sole Proprietor?:No
Enumeration Date:2014-01-03
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor