Individual
CAROL S DICKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
33 E JACKSON ST, MARSHALL, MO 65340-2153
(660) 886-8063
(660) 886-3051
Mailing address
PO BOX 7687, COLUMBIA, MO 65205-7687
(573) 882-2259
(573) 884-8526
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
SW004511
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
127133
BLUE SHIELD/BLUE CHOICE
MO
01
—
324643
HEALTHLINK
MO
01
—
K51A688
KANSAS MEDICARE
MO
Enumeration date
05/24/2006
Last updated
07/08/2007
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