Provider Demographics
NPI:1629364336
Name:DICKSON, KRISTINE D (BCBA)
Entity Type:Individual
Prefix:MS
First Name:KRISTINE
Middle Name:D
Last Name:DICKSON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12040 OTSEGO ST
Mailing Address - Street 2:
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-3120
Mailing Address - Country:US
Mailing Address - Phone:818-613-1206
Mailing Address - Fax:818-423-2214
Practice Address - Street 1:12750 VENTURA BLVD STE 102
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-2433
Practice Address - Country:US
Practice Address - Phone:323-839-9354
Practice Address - Fax:818-423-2214
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-21
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-11-8991103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst