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NPI Code Detail

MEDICARE: KATHERINE RUTH DICKERSON LCMHCS, LCAS, CCS

MEDICARE: KATHERINE RUTH DICKERSON LCMHCS, LCAS, CCS
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
1101YA0400XAddiction (Substance Use Disorder) CounselorLCAS-1406NC
2101YA0400XAddiction (Substance Use Disorder) CounselorCCS-10965NC
3101YM0800XMental Health CounselorCCS-10965NC
4101YM0800XMental Health CounselorS9956NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1780816603
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHERINE RUTH DICKERSON LCMHCS, LCAS, CCS
Provider Business Mailing Address
First Line : 7490 WATERSIDE CROSSING BLVD STE 2A
Second Line :
City : DENVER
State : NC
Zip : 28037-3004
Country : US
Telephone Number : 704-360-3637
Fax Number : 704-625-9789
Provider Business Practice Location Address
First Line : 7490 WATERSIDE CROSSING BLVD STE 2A
Second Line :
City : DENVER
State : NC
Zip : 28037-3004
Country : US
Telephone Number : 704-360-3637
Fax Number : 704-625-9789
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2009
Last Update Date : 12/15/2023

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