Provider Demographics
NPI:1770949836
Name:DICKEY, ALICYN
Entity type:Individual
Prefix:
First Name:ALICYN
Middle Name:
Last Name:DICKEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3656 JACKSON ST APT 10C
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32129-7622
Mailing Address - Country:US
Mailing Address - Phone:814-414-7603
Mailing Address - Fax:
Practice Address - Street 1:500 HEALTH BLVD STE 100
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-1558
Practice Address - Country:US
Practice Address - Phone:386-267-3161
Practice Address - Fax:386-236-1995
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-05
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-18-29437103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst