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General NPI Number Information
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NPI Number | 1629585765
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Entity Type | Individual
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Provider Name | DR. KATHERINE DICKINSON
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Gender | Female
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Dates
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Enumeration Date | 01/10/2018
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Last Update Date | 12/15/2022
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Provider Practice Location Address
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Address Line | 2139 MARYLAND CIR
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City | TALLAHASSEE
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State | FL
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Zip | 32303-1001
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Country | US
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Telephone | 850-644-9924
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Fax |
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Provider Business Mailing Address
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Address Line | 143 FLAMINGO CT
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City | MONTICELLO
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State | FL
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Zip | 32344-0892
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Country | US
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Telephone | 850-841-9836
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY004169
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 2272
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License Number State | AL
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PY10053
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License Number State | FL
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