Doctor Name: | PHYLLIS L DICKERSON |
NPI Number: | 1114204807 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCSW |
License Number: | 2253C |
Business Practice Address: | 301 Fisher St Keesler Afb, MS - 395342508 |
Business Phone Number: | 2283763395 |
Business Fax Number: | 2283760103 |
Mailing Address: | 301 Fisher St, KEESLER AFB |
State: | MS |
Postal Code: | 395342508 |
Phone Number: | 2283763395 |
Fax Number: | 2283760103 |
NPI Enumeration Date: | 11/08/2011 |
NPI Last Update Date: | 11/08/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 2253C |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |