Provider Demographics
NPI:1972693604
Name:DICKINSON, CHERI (MSW, LMSW)
Entity Type:Individual
Prefix:
First Name:CHERI
Middle Name:
Last Name:DICKINSON
Suffix:
Gender:F
Credentials:MSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5434 FERN AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-4320
Mailing Address - Country:US
Mailing Address - Phone:810-695-4312
Mailing Address - Fax:
Practice Address - Street 1:2360 S LINDEN RD
Practice Address - Street 2:SUITE 300
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-5420
Practice Address - Country:US
Practice Address - Phone:810-732-0560
Practice Address - Fax:810-732-6351
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010674011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIF37005092Medicare ID - Type Unspecified