Healthcare Provider Details

I. General information

NPI: 1679257067
Provider Name (Legal Business Name): MIRANDA JO DICKENS MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2023
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 TREMONT PARK DR NE
LENOIR NC
28645-4642
US

IV. Provider business mailing address

144 TREMONT PARK DR NE
LENOIR NC
28645-4642
US

V. Phone/Fax

Practice location:
  • Phone: 828-439-8191
  • Fax: 828-439-2622
Mailing address:
  • Phone: 828-439-8191
  • Fax: 828-439-2622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC020177
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: