Provider Demographics
NPI:1699958496
Name:DICKERSON, ANGELINA BARROS (PSYD)
Entity type:Individual
Prefix:DR
First Name:ANGELINA
Middle Name:BARROS
Last Name:DICKERSON
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 1:639 ATLANTIC ST SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-3738
Mailing Address - Country:US
Mailing Address - Phone:202-849-2915
Mailing Address - Fax:202-627-2058
Practice Address - Street 1:639 ATLANTIC ST SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-3738
Practice Address - Country:US
Practice Address - Phone:202-849-2915
Practice Address - Fax:202-627-5028
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-14
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04233103TC0700X
DCPSY1000835103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical