MEDICARE: STEPHEN E DICKERSON MS, LCAS, LCMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	A17103	NC
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	LCAS-27181	NC

General Provider Information

NPI Number	:	1134791080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN E DICKERSON MS, LCAS, LCMHC

Provider Business Mailing Address
First Line	:	780 BUNDABERG LN
Second Line	:
City	:	RURAL HALL
State	:	NC
Zip	:	27045-9752
Country	:	US
Telephone Number	:	336-995-3243
Fax Number	:

Provider Business Practice Location Address
First Line	:	7 DUNDAS CIR STE L
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27407-1645
Country	:	US
Telephone Number	:	828-655-2931
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2021
Last Update Date	:	06/03/2026

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