Provider Demographics
NPI:1841902673
Name:DICKEY, SYLVONIA DEHAVEN (LCAS-A)
Entity type:Individual
Prefix:
First Name:SYLVONIA
Middle Name:DEHAVEN
Last Name:DICKEY
Suffix:
Gender:F
Credentials:LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2148 HWY 401 BUSINESS
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376
Mailing Address - Country:US
Mailing Address - Phone:910-565-2857
Mailing Address - Fax:910-248-6258
Practice Address - Street 1:2148 HWY 401 BUSINESS
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376
Practice Address - Country:US
Practice Address - Phone:910-565-2857
Practice Address - Fax:910-248-6258
Is Sole Proprietor?:No
Enumeration Date:2022-12-26
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0186381041C0700X
NC28770101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical