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General NPI Number Information
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NPI Number | 1134877509
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Entity Type | Individual
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Provider Name | KATHY DICKERSON LPC
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Gender | Female
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Dates
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Enumeration Date | 03/15/2022
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Last Update Date | 03/15/2022
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Provider Practice Location Address
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Address Line | 398 E MAIN ST STE 206
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City | TUPELO
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State | MS
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Zip | 38804-4037
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Country | US
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Telephone | 662-591-1141
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Fax |
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Provider Business Mailing Address
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Address Line | 949 ROAD 1310
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City | MOOREVILLE
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State | MS
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Zip | 38857-8105
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Country | US
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Telephone | 662-871-4352
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 1172
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License Number State | MS
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