Provider Demographics
NPI:1104871151
Name:DICKERSON, CAROL S (LCSW)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:S
Last Name:DICKERSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:M
Other - Last Name:SACHSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 7687
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65205-7687
Mailing Address - Country:US
Mailing Address - Phone:573-882-2259
Mailing Address - Fax:573-884-8526
Practice Address - Street 1:33 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MO
Practice Address - Zip Code:65340-2153
Practice Address - Country:US
Practice Address - Phone:660-886-8063
Practice Address - Fax:660-886-3051
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOSW0045111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOK51A688OtherKANSAS MEDICARE
MO127133OtherBLUE SHIELD/BLUE CHOICE
MO324643OtherHEALTHLINK
S51474Medicare UPIN