Individual
KENNETH WILLIE DICKERSON SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
15530 ELLA BLVD APT 719, HOUSTON, TX 77090
(832) 892-1079
Mailing address
15530 ELLA BLVD APT 719, HOUSTON, TX 77090-5310
(832) 892-1079
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
24512126
TX
405300000X
Prevention Professional
24512126
TX
Other
Enumeration date
04/19/2017
Last updated
04/19/2017
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