Provider Demographics
NPI:1548479892
Name:FICK, DORENE P (LCSW-R)
Entity type:Individual
Prefix:MS
First Name:DORENE
Middle Name:P
Last Name:FICK
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 N MILL RD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-2912
Mailing Address - Country:US
Mailing Address - Phone:540-389-5657
Mailing Address - Fax:540-772-5157
Practice Address - Street 1:1409 GRANDIN RD SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24015-2317
Practice Address - Country:US
Practice Address - Phone:540-225-2835
Practice Address - Fax:540-339-7235
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY056891-R1041C0700X
VA0904067691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical