Healthcare Provider Details

I. General information

NPI: 1356276430
Provider Name (Legal Business Name): MS. DIONE K VICKERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

597 OLD MOUNT HOLLY RD STE 307
GOOSE CREEK SC
29445-2834
US

IV. Provider business mailing address

507 FRONT ST # 2087
SUMMERVILLE SC
29486-7919
US

V. Phone/Fax

Practice location:
  • Phone: 843-212-6642
  • Fax:
Mailing address:
  • Phone: 843-970-0735
  • Fax: 210-579-8766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number2320
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number17206
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: