Provider Demographics
NPI:1780431700
Name:DICKERSON, DELAVANTE (RBT)
Entity type:Individual
Prefix:
First Name:DELAVANTE
Middle Name:
Last Name:DICKERSON
Suffix:
Gender:
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 N STEPHANIE ST STE 1514
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-8902
Mailing Address - Country:US
Mailing Address - Phone:702-550-2791
Mailing Address - Fax:702-745-0488
Practice Address - Street 1:375 N STEPHANIE ST STE 1514
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-8902
Practice Address - Country:US
Practice Address - Phone:702-550-2791
Practice Address - Fax:702-745-0488
Is Sole Proprietor?:No
Enumeration Date:2024-05-06
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRBT-24-344905106S00000X
NVRBT4253106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician