Provider Demographics
NPI:1396186250
Name:DICKERSON, AMY ELIZABETH (MS)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:ELIZABETH
Last Name:DICKERSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 26749
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86312-6749
Mailing Address - Country:US
Mailing Address - Phone:909-532-2571
Mailing Address - Fax:855-978-2704
Practice Address - Street 1:12251 E SIDE SADDLE LN
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86315-8162
Practice Address - Country:US
Practice Address - Phone:909-532-2571
Practice Address - Fax:855-978-2704
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-08
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC52821106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist