Healthcare Provider Details

I. General information

NPI: 1154660900
Provider Name (Legal Business Name): MARCIA DICKSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2013
Last Update Date: 02/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CLINTON AVE
CLOVER SC
29710-1627
US

IV. Provider business mailing address

300 CLINTON AVE
CLOVER SC
29710-1627
US

V. Phone/Fax

Practice location:
  • Phone: 803-810-8402
  • Fax: 803-222-8043
Mailing address:
  • Phone: 803-810-8402
  • Fax: 803-222-8043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number1952
License Number StateSC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: