Provider Demographics
NPI:1417385733
Name:DICKERSON, JAMIE LEE (MA LPC, LMFT)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:LEE
Last Name:DICKERSON
Suffix:
Gender:F
Credentials:MA LPC, LMFT
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:LEE
Other - Last Name:VANDEVUSSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LLPC, LLMFT
Mailing Address - Street 1:3333 DEPOSIT DR NE STE 120
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-1467
Mailing Address - Country:US
Mailing Address - Phone:616-805-3660
Mailing Address - Fax:
Practice Address - Street 1:325 84TH ST SW STE 102
Practice Address - Street 2:
Practice Address - City:BYRON CENTER
Practice Address - State:MI
Practice Address - Zip Code:49315-9350
Practice Address - Country:US
Practice Address - Phone:616-805-3660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-23
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401013974101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional