Provider Demographics
NPI:1396211454
Name:DICKSON, ANGELINE BK (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ANGELINE
Middle Name:BK
Last Name:DICKSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1178 AKIPOLA ST
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-4259
Mailing Address - Country:US
Mailing Address - Phone:808-953-8306
Mailing Address - Fax:
Practice Address - Street 1:932 WARD AVE STE 490
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-2193
Practice Address - Country:US
Practice Address - Phone:808-379-3031
Practice Address - Fax:808-892-4675
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-16
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1714103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist