Provider Demographics
NPI:1649454190
Name:DICKINSON, CLARITY
Entity type:Individual
Prefix:
First Name:CLARITY
Middle Name:
Last Name:DICKINSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1302 S MADISON ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1435
Mailing Address - Country:US
Mailing Address - Phone:253-572-2488
Mailing Address - Fax:253-572-2488
Practice Address - Street 1:1302 S MADISON ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1435
Practice Address - Country:US
Practice Address - Phone:253-572-2488
Practice Address - Fax:253-572-2488
Is Sole Proprietor?:No
Enumeration Date:2007-12-19
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF60517890101Y00000X
106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor