Provider Demographics
NPI:1205035433
Name:DICKERSON COUNSELING, L.L.C.
Entity Type:Organization
Organization Name:DICKERSON COUNSELING, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:DICKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:406-752-0530
Mailing Address - Street 1:17 2ND ST E
Mailing Address - Street 2:SUITE #204
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-6107
Mailing Address - Country:US
Mailing Address - Phone:406-752-0530
Mailing Address - Fax:
Practice Address - Street 1:17 2ND ST E
Practice Address - Street 2:SUITE #204
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-6107
Practice Address - Country:US
Practice Address - Phone:406-752-0530
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1192 LAC101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty