Provider Demographics
NPI:1558100461
Name:DICKERSON, JANECE JEANNE (LCSW)
Entity type:Individual
Prefix:
First Name:JANECE
Middle Name:JEANNE
Last Name:DICKERSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1075 W STATE ST APT A202
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-8131
Mailing Address - Country:US
Mailing Address - Phone:256-513-1486
Mailing Address - Fax:
Practice Address - Street 1:1075 W STATE ST APT A202
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-8131
Practice Address - Country:US
Practice Address - Phone:256-513-1486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1225261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical