Basic Information
| Provider Information | |||||||||
| NPI: | 1942413968 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DICKERSON | ||||||||
| FirstName: | JULIE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MS, LPC, NCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 108 | ||||||||
| Address2: | |||||||||
| City: | BISMARCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 719290108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016278385 | ||||||||
| FaxNumber: | 5018653362 | ||||||||
| Practice Location | |||||||||
| Address1: | 3399 FINCH ROAD | ||||||||
| Address2: | |||||||||
| City: | BISMARCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 71929 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5018653363 | ||||||||
| FaxNumber: | 5018653362 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | P0010028 | AR | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.