Provider Demographics
NPI:1972652683
Name:DICKERSON, ANDREA D (IADC, LMFT)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:D
Last Name:DICKERSON
Suffix:
Gender:F
Credentials:IADC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 N EISENHOWER AVE
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-7340
Mailing Address - Country:US
Mailing Address - Phone:515-233-4930
Mailing Address - Fax:
Practice Address - Street 1:804 KELLOGG AVE
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-6234
Practice Address - Country:US
Practice Address - Phone:515-233-4930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00112101YA0400X
IA415106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)