Individual
STACCOTTA DICKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
X
Contact information
Practice address
200 12TH STREET EXT, PRINCETON, WV 24740-2329
(304) 425-9541
Mailing address
200 12TH STREET EXT, PRINCETON, WV 24740-2329
(304) 425-9541
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
1740234673
WV
Other
Enumeration date
05/06/2026
Last updated
05/06/2026
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