| Phyllis L Dickerson Lcsw | |
|
8990 Lorraine Rd Gulfport MS 39503-4176 | |
| (228) 331-3310 | |
| Not Available |
| Full Name | Phyllis L Dickerson Lcsw |
|---|---|
| Speciality | Social Worker |
| Location | 8990 Lorraine Rd, Gulfport, Mississippi |
| Authorized Official Name and Position | Phyllis L Dickerson (OWNER) |
| Authorized Official Contact | 2283313310 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Phyllis L Dickerson Lcsw 8990 Lorraine Rd Gulfport MS 39503-4176 Ph: (228) 331-3310 | Phyllis L Dickerson Lcsw 8990 Lorraine Rd Gulfport MS 39503-4176 Ph: (228) 331-3310 |
| NPI Number | 1750802534 |
|---|---|
| Provider Enumeration Date | 06/30/2017 |
| Last Update Date | 07/21/2022 |
| Medicare PECOS PAC ID | 9537413810 |
|---|---|
| Medicare Enrollment ID | O20181127000699 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750802534 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | C5893 (Mississippi) | Primary |
| Provider Name | Phyllis L Dickerson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1114204807 PECOS PAC ID: 0446504724 Enrollment ID: I20181127002689 |
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