Provider Demographics
NPI:1881825537
Name:DICKSON, SHEILA BLYTHE (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHEILA
Middle Name:BLYTHE
Last Name:DICKSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3561 PHILLIPS AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95407-8075
Mailing Address - Country:US
Mailing Address - Phone:707-585-2451
Mailing Address - Fax:
Practice Address - Street 1:3561 PHILLIPS AVE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95407-8075
Practice Address - Country:US
Practice Address - Phone:707-585-2451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-29
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20778103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist