Provider Demographics
NPI:1740018100
Name:DICKSON, CARTER EARL
Entity type:Individual
Prefix:
First Name:CARTER
Middle Name:EARL
Last Name:DICKSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:758 POTATO PATCH DR
Mailing Address - Street 2:
Mailing Address - City:VAIL
Mailing Address - State:CO
Mailing Address - Zip Code:81657-4427
Mailing Address - Country:US
Mailing Address - Phone:303-317-6504
Mailing Address - Fax:
Practice Address - Street 1:758 POTATO PATCH DR
Practice Address - Street 2:
Practice Address - City:VAIL
Practice Address - State:CO
Practice Address - Zip Code:81657-4427
Practice Address - Country:US
Practice Address - Phone:303-317-6504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health