Provider Demographics
NPI:1093271942
Name:DICKERSON-GUERRA, LISA RHIANNON (LCSW-C)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:RHIANNON
Last Name:DICKERSON-GUERRA
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5513 VANTAGE POINT RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-2631
Mailing Address - Country:US
Mailing Address - Phone:617-838-0156
Mailing Address - Fax:
Practice Address - Street 1:5513 VANTAGE POINT RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2631
Practice Address - Country:US
Practice Address - Phone:617-838-0156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-15
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD207321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical