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General NPI Number Information
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NPI Number | 1659960136
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Entity Type | Individual
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Provider Name | TIA N DICKERSON LLMFT, LLPC
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Gender | Female
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Dates
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Enumeration Date | 01/11/2021
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Last Update Date | 07/08/2024
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Provider Practice Location Address
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Address Line | 1056 ORNDORF DR STE G
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City | BRIGHTON
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State | MI
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Zip | 48116-2479
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Country | US
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Telephone | 734-386-0041
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Fax |
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Provider Business Mailing Address
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Address Line | 551 SUNNINGDALE DR
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City | INKSTER
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State | MI
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Zip | 48141-1238
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Country | US
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Telephone | 313-394-9610
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 4151001014
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6451022116
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License Number State | MI
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