Provider Demographics
NPI:1295510139
Name:DICKSON, CHRISTOPHER MICHAEL (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:MICHAEL
Last Name:DICKSON
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:CHRISTOPHER
Other - Middle Name:MICHAEL
Other - Last Name:DICKSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:PO BOX 2271
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80522-2271
Mailing Address - Country:US
Mailing Address - Phone:970-232-8887
Mailing Address - Fax:
Practice Address - Street 1:279 W QUANDARY CT
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CO
Practice Address - Zip Code:80536-8743
Practice Address - Country:US
Practice Address - Phone:970-232-8887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-29
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLSW.0009923883101YM0800X
COCSW.099303951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health