Provider Demographics
NPI:1386895415
Name:DICKERSON, ANNE GODFREY (LPC)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:GODFREY
Last Name:DICKERSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4950 PARK RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-3506
Mailing Address - Country:US
Mailing Address - Phone:704-523-4881
Mailing Address - Fax:704-523-4854
Practice Address - Street 1:4950 PARK RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-3506
Practice Address - Country:US
Practice Address - Phone:704-523-4881
Practice Address - Fax:704-523-4854
Is Sole Proprietor?:No
Enumeration Date:2008-10-07
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4412101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional