Healthcare Provider Details

I. General information

NPI: 1104593201
Provider Name (Legal Business Name): ANNA DICKINSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2021
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 LEGION ST STE 200B
CONWAY SC
29526-4825
US

IV. Provider business mailing address

1772 VEREEN RD
AYNOR SC
29511-6804
US

V. Phone/Fax

Practice location:
  • Phone: 843-448-4820
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number9698
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: