Provider Demographics
NPI:1629585765
Name:DICKINSON, KATHERINE
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:
Last Name:DICKINSON
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:KATE
Other - Middle Name:
Other - Last Name:HARRISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:143 FLAMINGO CT
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:FL
Mailing Address - Zip Code:32344-0892
Mailing Address - Country:US
Mailing Address - Phone:850-841-9836
Mailing Address - Fax:
Practice Address - Street 1:2139 MARYLAND CIR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-1001
Practice Address - Country:US
Practice Address - Phone:850-644-9924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-10
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY004169103T00000X
AL2272103T00000X
FLPY10053103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist