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GRACE E DICKERSON LMFT

>> Marriage & Family Therapist >> Behavioral Health & Social Service Providers

Registrant NPI Number: 1578795175

Individual Registrant:
 GRACE E DICKERSON LMFT
Gender: F
Not Sole Proprietor

Location and contact information for practice:
914C WPA RD  SUMRALL, MS 39482-3780 US
Tel: 601-705-1901  Fax: --

Contact information for business:
914C WPA RD  SUMRALL, MS 39482-3780 US
Tel: 601-705-1901  Fax: --

Registration Information:
NPI: 1578795175
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y106H00000XBehavioral Health & Social Service Providers
Marriage & Family Therapist
MSM7415

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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