Provider Demographics
NPI:1548274830
Name:DICKISON, JULIE A (PSYD)
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:A
Last Name:DICKISON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 NORTH CENTER STREET
Mailing Address - Street 2:SUITE 003
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601
Mailing Address - Country:US
Mailing Address - Phone:828-315-5577
Mailing Address - Fax:828-315-5950
Practice Address - Street 1:415 N CENTER ST
Practice Address - Street 2:SUITE 003
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-5036
Practice Address - Country:US
Practice Address - Phone:828-315-5577
Practice Address - Fax:828-315-5950
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-29
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2342 HSP-P103T00000X, 103TC0700X, 103TH0100X, 103TP2701X
NC2342103T00000X, 103TC0700X, 103TH0004X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0426LOtherBCBS PROVIDER NUMBER
NC0426LOtherBCBS PROVIDER NUMBER