Provider Demographics
NPI:1396010765
Name:DICKERSON, JENNIFER (LPC-INTERN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:DICKERSON
Suffix:
Gender:F
Credentials:LPC-INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6750 HILLCREST PLAZA DR
Mailing Address - Street 2:SUITE 221
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-1400
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6750 HILLCREST PLAZA DR
Practice Address - Street 2:SUITE 221
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-1400
Practice Address - Country:US
Practice Address - Phone:972-385-7447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-17
Last Update Date:2012-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63800101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional