Provider Demographics
NPI:1306240791
Name:DICKSON, CAROLE (CAC III)
Entity type:Individual
Prefix:
First Name:CAROLE
Middle Name:
Last Name:DICKSON
Suffix:
Gender:F
Credentials:CAC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 E 18TH AVE STE C
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-1225
Mailing Address - Country:US
Mailing Address - Phone:303-062-9529
Mailing Address - Fax:303-534-2431
Practice Address - Street 1:2222 E 18TH AVE STE C
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-1225
Practice Address - Country:US
Practice Address - Phone:303-062-9529
Practice Address - Fax:303-534-2431
Is Sole Proprietor?:No
Enumeration Date:2014-10-15
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACC.0005187101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)