Provider Demographics
NPI:1982718128
Name:DICKSON, DEBBIE ELAINE (LISW)
Entity type:Individual
Prefix:
First Name:DEBBIE
Middle Name:ELAINE
Last Name:DICKSON
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41191 TR 78
Mailing Address - Street 2:
Mailing Address - City:COSHOCTON
Mailing Address - State:OH
Mailing Address - Zip Code:43812
Mailing Address - Country:US
Mailing Address - Phone:740-587-2822
Mailing Address - Fax:740-587-2822
Practice Address - Street 1:905 RIVER RD STE A
Practice Address - Street 2:
Practice Address - City:GRANVILLE
Practice Address - State:OH
Practice Address - Zip Code:43023-9560
Practice Address - Country:US
Practice Address - Phone:740-587-2822
Practice Address - Fax:740-587-2822
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHIOOO57761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical