Provider Demographics
NPI:1225676786
Name:DICKERSON, MARSHA (RECOVERY SPECIALIST)
Entity Type:Individual
Prefix:
First Name:MARSHA
Middle Name:
Last Name:DICKERSON
Suffix:
Gender:F
Credentials:RECOVERY SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 SW 43RD ST STE K532B
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-4900
Mailing Address - Country:US
Mailing Address - Phone:206-484-8907
Mailing Address - Fax:
Practice Address - Street 1:7224 PACIFIC HWY E
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:WA
Practice Address - Zip Code:98354
Practice Address - Country:US
Practice Address - Phone:253-220-6183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-16
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60954399101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor