Provider Demographics
NPI:1528310174
Name:DICKARD, TAMMY S (PCC)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:S
Last Name:DICKARD
Suffix:
Gender:F
Credentials:PCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9853 JOHNNYCAKE RIDGE RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-6700
Mailing Address - Country:US
Mailing Address - Phone:440-975-6592
Mailing Address - Fax:440-975-6592
Practice Address - Street 1:9853 JOHNNYCAKE RIDGE RD
Practice Address - Street 2:SUITE 206
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-6700
Practice Address - Country:US
Practice Address - Phone:440-975-6592
Practice Address - Fax:440-975-6592
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-05
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0800516101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional