Individual
JEREMY LYNN DICICCO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
10 HYTEN, BENTON, AR 72015-3831
(804) 592-1205
Mailing address
10 HYTEN, BENTON, AR 72015-3831
(804) 592-1205
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
225C00000X
Rehabilitation Counselor
Primary
—
—
Other
Enumeration date
11/11/2009
Last updated
02/03/2023
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