Provider Demographics
NPI:1407108970
Name:DICKINSON, LISA ANN (LMFT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:DICKINSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4993 GOLDEN FOOTHILL PARKWAY
Mailing Address - Street 2:SUITE 6
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762
Mailing Address - Country:US
Mailing Address - Phone:805-479-1148
Mailing Address - Fax:
Practice Address - Street 1:4993 GOLDEN FOOTHILL PKWY STE 6
Practice Address - Street 2:
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-9642
Practice Address - Country:US
Practice Address - Phone:805-479-1148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 52228106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist