Healthcare Provider Details

I. General information

NPI: 1962496190
Provider Name (Legal Business Name): PATRICIA S DICKINSON PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/02/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date: 03/24/2006
Reactivation Date: 03/31/2006

III. Provider practice location address

318A E MAIN ST
HAVELOCK NC
28532-2214
US

IV. Provider business mailing address

318A E MAIN ST
HAVELOCK NC
28532-2214
US

V. Phone/Fax

Practice location:
  • Phone: 252-447-7764
  • Fax: 252-444-6800
Mailing address:
  • Phone: 252-447-7764
  • Fax: 252-444-6800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2670
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: