Provider Demographics
NPI:1710509997
Name:DICKERSON FAMILY RESOURCE CENTER, LLC
Entity Type:Organization
Organization Name:DICKERSON FAMILY RESOURCE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SABRINA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:DICKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, CRC
Authorized Official - Phone:501-580-4999
Mailing Address - Street 1:14 KAYE LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72076-2402
Mailing Address - Country:US
Mailing Address - Phone:501-580-4999
Mailing Address - Fax:501-222-1080
Practice Address - Street 1:5401 JOHN F. KENNEDY BLVD
Practice Address - Street 2:SUITE I RM 1
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116
Practice Address - Country:US
Practice Address - Phone:501-580-4999
Practice Address - Fax:501-222-1080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-11
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty