Provider Demographics
NPI:1407906837
Name:DICKSON-GREGORY, DORCAS (LPT)
Entity Type:Individual
Prefix:
First Name:DORCAS
Middle Name:
Last Name:DICKSON-GREGORY
Suffix:
Gender:F
Credentials:LPT
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Mailing Address - Street 1:5810 RALSTON ST FL 2
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-6010
Mailing Address - Country:US
Mailing Address - Phone:805-624-7033
Mailing Address - Fax:805-642-7732
Practice Address - Street 1:5810 RALSTON ST FL 2
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-6010
Practice Address - Country:US
Practice Address - Phone:805-642-7033
Practice Address - Fax:805-642-7732
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPT8055167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician