Healthcare Provider Details

I. General information

NPI: 1417385733
Provider Name (Legal Business Name): JAMIE LEE DICKERSON M.A. LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JAMIE LEE VANDEVUSSE LLPC, LLMFT

II. Dates (important events)

Enumeration Date: 10/23/2013
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 JENNER DR
ALLEGAN MI
49010-1517
US

IV. Provider business mailing address

3333 DEPOSIT DR NE STE 120
GRAND RAPIDS MI
49546-1468
US

V. Phone/Fax

Practice location:
  • Phone: 269-673-3384
  • Fax:
Mailing address:
  • Phone: 616-805-3660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401013974
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: