Provider Demographics
NPI:1134403652
Name:DICKERSON, ANGELA J (LSW)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:J
Last Name:DICKERSON
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:GARLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:920 EXECUTIVE DR
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:IN
Mailing Address - Zip Code:47960-1961
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:920 EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:IN
Practice Address - Zip Code:47960-1961
Practice Address - Country:US
Practice Address - Phone:574-583-7997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-03
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33006080A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker