Provider Demographics
NPI:1427123744
Name:DICKERSON, ERIN M (LCSW)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:M
Last Name:DICKERSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:M
Other - Last Name:KLEINDORFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11075 VILLAGE SQUARE LN
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-4552
Mailing Address - Country:US
Mailing Address - Phone:317-598-9997
Mailing Address - Fax:
Practice Address - Street 1:11075 VILLAGE SQUARE LN
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-4552
Practice Address - Country:US
Practice Address - Phone:317-598-9997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34003984A1041C0700X
INC874101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)