Healthcare Provider Details

I. General information

NPI: 1912281387
Provider Name (Legal Business Name): RITA JOY DICKSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RITA JOY PURYEAR LAC

II. Dates (important events)

Enumeration Date: 10/04/2011
Last Update Date: 06/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2239 S CARAWAY RD SUITE M
JONESBORO AR
72401-6204
US

IV. Provider business mailing address

1600 ALDERSGATE RD SUITE 200
LITTLE ROCK AR
72205-6676
US

V. Phone/Fax

Practice location:
  • Phone: 870-910-3757
  • Fax: 870-910-4999
Mailing address:
  • Phone: 501-661-0720
  • Fax: 501-325-7938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberA1108085
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP1603030
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: