Provider Demographics
NPI:1093951105
Name:DICKENS, ANITA CELESTE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:ANITA
Middle Name:CELESTE
Last Name:DICKENS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5198 CR 6000
Mailing Address - Street 2:
Mailing Address - City:CHERRYVALE
Mailing Address - State:KS
Mailing Address - Zip Code:67335-8550
Mailing Address - Country:US
Mailing Address - Phone:620-330-2720
Mailing Address - Fax:
Practice Address - Street 1:3101 N MICHIGAN ST STE C
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:KS
Practice Address - Zip Code:66762-2574
Practice Address - Country:US
Practice Address - Phone:620-231-1069
Practice Address - Fax:620-231-2997
Is Sole Proprietor?:No
Enumeration Date:2008-12-18
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS67561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical