Provider Demographics
NPI:1083743439
Name:DICKEY, CALISTA CHRISTINE (L AC, DIPL AC)
Entity Type:Individual
Prefix:MRS
First Name:CALISTA
Middle Name:CHRISTINE
Last Name:DICKEY
Suffix:
Gender:F
Credentials:L AC, DIPL AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:924 DEWEY AVE
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-3941
Mailing Address - Country:US
Mailing Address - Phone:301-797-9766
Mailing Address - Fax:
Practice Address - Street 1:201 S CLEVELAND AVE
Practice Address - Street 2:SUITE 404
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-5745
Practice Address - Country:US
Practice Address - Phone:301-797-2297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU000893171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDJ801-0001OtherBLUE CROSS BLUE SHIELD
MD1006186OtherAMERICAN HEALTH SPECIALTI
MDBL98CCOtherBLUE CROSS BLUE SHIELD
MD2095285OtherFIRST HEALTH