Provider Demographics
NPI:1720494586
Name:DICKENS, AVA WILLIAMS (MS)
Entity Type:Individual
Prefix:
First Name:AVA
Middle Name:WILLIAMS
Last Name:DICKENS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3956 STAFFORD RUN CT
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-9480
Mailing Address - Country:US
Mailing Address - Phone:336-580-0116
Mailing Address - Fax:
Practice Address - Street 1:3956 STAFFORD RUN CT
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-9480
Practice Address - Country:US
Practice Address - Phone:336-580-0116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-01
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA10828101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health