Provider Demographics
NPI:1184164832
Name:DICKSON, JENNIFER KELSEY (LPC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:KELSEY
Last Name:DICKSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 FAIRGROUNDS RD
Mailing Address - Street 2:
Mailing Address - City:FARMVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23901-5401
Mailing Address - Country:US
Mailing Address - Phone:434-547-8989
Mailing Address - Fax:
Practice Address - Street 1:217 W 3RD ST
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:VA
Practice Address - Zip Code:23901-1303
Practice Address - Country:US
Practice Address - Phone:434-392-4074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-28
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701006960101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional