Provider Demographics
NPI:1780100750
Name:DICKISON, DARCI (LATC)
Entity type:Individual
Prefix:
First Name:DARCI
Middle Name:
Last Name:DICKISON
Suffix:
Gender:F
Credentials:LATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 960
Mailing Address - Street 2:
Mailing Address - City:MISENHEIMER
Mailing Address - State:NC
Mailing Address - Zip Code:28109-0960
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:48380 US 52
Practice Address - Street 2:
Practice Address - City:MISENHEIMER
Practice Address - State:NC
Practice Address - Zip Code:28108-2810
Practice Address - Country:US
Practice Address - Phone:704-356-0639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-21
Last Update Date:2017-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLAT-29732255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer