Provider Demographics
NPI:1578690004
Name:DICKSON, ANGELA W (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:W
Last Name:DICKSON
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:MS
Other - First Name:ANGELA
Other - Middle Name:O
Other - Last Name:WORKMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:333 W MAIN ST
Mailing Address - Street 2:STE 210
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-6320
Mailing Address - Country:US
Mailing Address - Phone:580-224-2929
Mailing Address - Fax:
Practice Address - Street 1:1255 THREE OAKS CIR
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73130-5310
Practice Address - Country:US
Practice Address - Phone:405-308-2528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK35251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200361440AMedicaid