MEDICARE: MS. KRISTINA MICHELLE DICKINSON

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	CIT-5972	LA

General Provider Information

NPI Number	:	1528955663
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KRISTINA MICHELLE DICKINSON

Provider Business Mailing Address
First Line	:	1110 N 7TH ST
Second Line	:
City	:	WEST MONROE
State	:	LA
Zip	:	71291-4334
Country	:	US
Telephone Number	:	318-855-0111
Fax Number	:	318-855-0117

Provider Business Practice Location Address
First Line	:	1110 N 7TH ST
Second Line	:
City	:	WEST MONROE
State	:	LA
Zip	:	71291-4334
Country	:	US
Telephone Number	:	318-855-0111
Fax Number	:	318-855-0117

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

Provider Enumeration Date	:	06/20/2025
Last Update Date	:	06/20/2025

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