Healthcare Provider Details

I. General information

NPI: 1932534948
Provider Name (Legal Business Name): COURTNEY S DICKERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COURTNEY SUE CROSS

II. Dates (important events)

Enumeration Date: 09/09/2013
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6211 TAYLOR DR
FLINT MI
48507-4665
US

IV. Provider business mailing address

413 MAPLE DR
LINDEN MI
48451-8946
US

V. Phone/Fax

Practice location:
  • Phone: 810-237-0799
  • Fax:
Mailing address:
  • Phone: 810-397-7046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number61576
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: