Healthcare Provider Details

I. General information

NPI: 1134052673
Provider Name (Legal Business Name): BAILEY KATHERINE GRANT-DICKERSON RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

982 MAIN ST.
DILLWYN VA
23936-3019
US

IV. Provider business mailing address

1035 POPLAR FOREST RD # 1035
FARMVILLE VA
23901-4524
US

V. Phone/Fax

Practice location:
  • Phone: 434-394-0703
  • Fax: 434-338-1974
Mailing address:
  • Phone: 804-877-2934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-467767
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: