Provider Demographics
NPI:1952588436
Name:DICKSON, DAVID P (LAC CCS)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:P
Last Name:DICKSON
Suffix:
Gender:M
Credentials:LAC CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1318 FLORIDA BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70726-4600
Mailing Address - Country:US
Mailing Address - Phone:225-243-5573
Mailing Address - Fax:225-243-6029
Practice Address - Street 1:1318 FLORIDA BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726-4600
Practice Address - Country:US
Practice Address - Phone:225-243-5573
Practice Address - Fax:225-243-6029
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-27
Last Update Date:2008-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA576101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)