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General NPI Number Information
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NPI Number | 1114401759
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Entity Type | Individual
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Provider Name | ASHA S DICKERSON PHD, LPC, NCC, CPCS
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Gender | Female
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Dates
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Enumeration Date | 09/19/2018
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Last Update Date | 09/19/2018
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Provider Practice Location Address
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Address Line | 10 CROSS CREEK DR
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City | LILBURN
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State | GA
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Zip | 30047-7054
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Country | US
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Telephone | 404-904-9188
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 28551
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City | ATLANTA
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State | GA
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Zip | 30358-0551
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Country | US
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Telephone | 404-904-9188
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | LPC008339
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License Number State | GA
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