Provider Demographics
NPI:1902190069
Name:MACALUSO-DICKERSON, CONNIE (LCSW, NCC)
Entity Type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:
Last Name:MACALUSO-DICKERSON
Suffix:
Gender:F
Credentials:LCSW, NCC
Other - Prefix:MS
Other - First Name:CONNIE
Other - Middle Name:
Other - Last Name:MACALUSO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW, NCC
Mailing Address - Street 1:6624 CORCORAN DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832-7433
Mailing Address - Country:US
Mailing Address - Phone:804-201-0367
Mailing Address - Fax:
Practice Address - Street 1:14410 SOMMERVILLE CT
Practice Address - Street 2:SUITE 101
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-6813
Practice Address - Country:US
Practice Address - Phone:804-897-9355
Practice Address - Fax:804-897-9359
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040076551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical