Provider Demographics
NPI:1386442937
Name:DICKEY, ROSETTA L (CPRS, BHT)
Entity type:Individual
Prefix:MS
First Name:ROSETTA
Middle Name:L
Last Name:DICKEY
Suffix:
Gender:
Credentials:CPRS, BHT
Other - Prefix:
Other - First Name:ROSEY
Other - Middle Name:L
Other - Last Name:DICKEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CPRS
Mailing Address - Street 1:3965 PARLIAMENT PL APT 96
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-4334
Mailing Address - Country:US
Mailing Address - Phone:937-510-8310
Mailing Address - Fax:
Practice Address - Street 1:3965 PARLIAMENT PL APT 96
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-4334
Practice Address - Country:US
Practice Address - Phone:937-510-8310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-07
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPS.006069175T00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty