Healthcare Provider Details

I. General information

NPI: 1891621926
Provider Name (Legal Business Name): DORCAS LISA DICKSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9030 STATE ROUTE 108 STE A
COLUMBIA MD
21045-1990
US

IV. Provider business mailing address

9030 STATE ROUTE 108 STE A
COLUMBIA MD
21045-1990
US

V. Phone/Fax

Practice location:
  • Phone: 410-740-1901
  • Fax:
Mailing address:
  • Phone: 410-740-1901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: