Provider Demographics
NPI:1003215021
Name:DICKERSON, ASHLEY (LMFT-A)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:DICKERSON
Suffix:
Gender:F
Credentials:LMFT-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 BROADWAY STE 5
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79401-3209
Mailing Address - Country:US
Mailing Address - Phone:180-676-5260
Mailing Address - Fax:180-668-7595
Practice Address - Street 1:1313 BROADWAY STE 5
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79401-3209
Practice Address - Country:US
Practice Address - Phone:180-676-5260
Practice Address - Fax:180-668-7595
Is Sole Proprietor?:No
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX202160106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist