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Individual
MR. MARC T DICKER
Active
Individual
MR. MARC T DICKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC, LCPC
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
LCPC-127
KS
363A00000X
Physician Assistant
Primary
PA-15-00156
KS
363AM0700X
Medical Physician Assistant
PA-15-00156
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100352880A
—
KS
Enumeration date
09/01/2006
Last updated
12/22/2010
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