Provider Demographics
NPI:1609214592
Name:DICKSON, DENITA (MSW)
Entity Type:Individual
Prefix:
First Name:DENITA
Middle Name:
Last Name:DICKSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5748 JORDANAIRE PL
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-2038
Mailing Address - Country:US
Mailing Address - Phone:706-618-5526
Mailing Address - Fax:
Practice Address - Street 1:5748 JORDANAIRE PL
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-2038
Practice Address - Country:US
Practice Address - Phone:706-618-5526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-12
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0537509731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical