Provider Demographics
NPI:1194948570
Name:DICKSON, MINA ANN (LPC LMFT)
Entity type:Individual
Prefix:MRS
First Name:MINA
Middle Name:ANN
Last Name:DICKSON
Suffix:
Gender:F
Credentials:LPC LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 12TH ST
Mailing Address - Street 2:SUITE 4A
Mailing Address - City:FLORENCE
Mailing Address - State:OR
Mailing Address - Zip Code:97439
Mailing Address - Country:US
Mailing Address - Phone:541-999-6809
Mailing Address - Fax:805-435-7434
Practice Address - Street 1:1525 12TH ST
Practice Address - Street 2:SUITE 4A
Practice Address - City:FLORENCE
Practice Address - State:OR
Practice Address - Zip Code:97439
Practice Address - Country:US
Practice Address - Phone:541-999-6809
Practice Address - Fax:805-435-7434
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC1938101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional