Individual
DONNA DICKERHOFF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8402 CROSS PARK DR, AUSTIN, TX 78754-4595
(512) 697-8500
Mailing address
8402 CROSS PARK DR, AUSTIN, TX 78754-4595
(512) 697-8500
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
825
TX
Other
Enumeration date
12/04/2012
Last updated
12/04/2012
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