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General NPI Number Information
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NPI Number | 1518435759
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Entity Type | Individual
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Provider Name | VALENCIA DESHANE DICKERSON LPCC
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Gender | Female
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Dates
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Enumeration Date | 11/06/2018
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Last Update Date | 04/30/2019
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Provider Practice Location Address
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Address Line | 525 W 5TH ST
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City | COVINGTON
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State | KY
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Zip | 41011-1259
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Country | US
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Telephone | 606-356-9741
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Fax |
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Provider Business Mailing Address
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Address Line | 677 HAWTHORNE AVE
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City | CINCINNATI
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State | OH
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Zip | 45205-2318
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Country | US
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Telephone | 606-356-9741
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 243847
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 243847
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 243847
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License Number State | KY
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