MEDICARE: ANNE GODFREY DICKERSON LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	4412	NC

General Provider Information

NPI Number	:	1386895415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNE GODFREY DICKERSON LPC

Provider Business Mailing Address
First Line	:	4950 PARK RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28209-3506
Country	:	US
Telephone Number	:	704-523-4881
Fax Number	:	704-523-4854

Provider Business Practice Location Address
First Line	:	4950 PARK RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28209-3506
Country	:	US
Telephone Number	:	704-523-4881
Fax Number	:	704-523-4854

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/07/2008
Last Update Date	:	07/26/2010

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Directions to “ ANNE GODFREY DICKERSON LPC” Practice Location

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