Provider Demographics
NPI:1932432994
Name:DICKERSON, DEAN AMES (PHD)
Entity Type:Individual
Prefix:DR
First Name:DEAN
Middle Name:AMES
Last Name:DICKERSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1627 OAK AVE STE A
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-1072
Mailing Address - Country:US
Mailing Address - Phone:530-219-6144
Mailing Address - Fax:530-756-1368
Practice Address - Street 1:1627 OAK AVE
Practice Address - Street 2:SUITE A
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-1072
Practice Address - Country:US
Practice Address - Phone:530-756-0555
Practice Address - Fax:530-756-1368
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-09
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY06149103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical