Provider Demographics
NPI:1437350584
Name:DICKINSON, CARLY M (LCSW)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:M
Last Name:DICKINSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 N BROADWAY ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-1301
Mailing Address - Country:US
Mailing Address - Phone:502-867-1336
Mailing Address - Fax:502-867-8164
Practice Address - Street 1:115 N BROADWAY ST
Practice Address - Street 2:SUITE 1
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-1301
Practice Address - Country:US
Practice Address - Phone:502-867-1336
Practice Address - Fax:502-867-8164
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker