Provider Demographics
NPI:1841729720
Name:DICKSON-MILLS, JENNIE (LCSW)
Entity type:Individual
Prefix:
First Name:JENNIE
Middle Name:
Last Name:DICKSON-MILLS
Suffix:
Gender:F
Credentials:LCSW
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 3056
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27515-3056
Mailing Address - Country:US
Mailing Address - Phone:919-200-6641
Mailing Address - Fax:
Practice Address - Street 1:502 RIGSBEE AVE STE 203
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701-2475
Practice Address - Country:US
Practice Address - Phone:919-200-6641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-05
Last Update Date:2017-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0097121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical