Provider Demographics
NPI:1013489178
Name:CARL DICKERSON, EDD, LPC COUNSELING AND CONSULTING
Entity Type:Organization
Organization Name:CARL DICKERSON, EDD, LPC COUNSELING AND CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:T
Authorized Official - Last Name:DICKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:EDD, LPC
Authorized Official - Phone:678-431-2070
Mailing Address - Street 1:1595 PEACHTREE PKWY
Mailing Address - Street 2:SUITE 204, #227
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041
Mailing Address - Country:US
Mailing Address - Phone:678-431-2070
Mailing Address - Fax:
Practice Address - Street 1:1410 VINERY AVE
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-9716
Practice Address - Country:US
Practice Address - Phone:678-431-2070
Practice Address - Fax:470-281-5711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-28
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1215157045OtherNPI FOR THE PROVIDER
1215157045OtherNPI