Provider Demographics
NPI:1922407329
Name:DICKERSON, NICOLE (LPCC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:DICKERSON
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 NAHM ST STE 9
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-4362
Mailing Address - Country:US
Mailing Address - Phone:270-554-9278
Mailing Address - Fax:
Practice Address - Street 1:131 NAHM ST STE 9
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-4362
Practice Address - Country:US
Practice Address - Phone:270-554-9278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-21
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1725101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional