Provider Demographics
NPI:1215059332
Name:DICKERSON, EVERETT T (PHD)
Entity type:Individual
Prefix:DR
First Name:EVERETT
Middle Name:T
Last Name:DICKERSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 S UNION ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19805-3857
Mailing Address - Country:US
Mailing Address - Phone:302-391-0508
Mailing Address - Fax:
Practice Address - Street 1:216 S UNION ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-3857
Practice Address - Country:US
Practice Address - Phone:301-391-0508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00708500101YM0800X
MA7934-MH-CC101YM0800X
PAPC007573101YP2500X
103TC1900X, 103TC2200X
DEPC0000911101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent