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General NPI Number Information
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NPI Number | 1013101732
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Entity Type | Individual
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Provider Name | DWALLA DICKERSON
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Gender | Female
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Dates
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Enumeration Date | 09/06/2007
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Last Update Date | 09/06/2007
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Provider Practice Location Address
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Address Line | 700 N TRYON ST
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City | CHARLOTTE
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State | NC
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Zip | 28202-2222
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Country | US
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Telephone | 704-336-3210
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Fax |
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Provider Business Mailing Address
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Address Line | 4004 TROON DR SW
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City | CONCORD
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State | NC
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Zip | 28027-0408
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Country | US
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Telephone | 704-493-6983
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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