Individual
MICHAEL A DICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
8100 W EMERALD ST STE 150, BOISE, ID 83704-9057
(208) 375-0752
(208) 375-0796
Mailing address
8100 W EMERALD ST STE 150, BOISE, ID 83704-9057
(208) 375-0752
(208) 375-0796
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
ACADC - 76
ID
101YM0800X
Mental Health Counselor
Primary
LCSW - 28518
ID
Other
Enumeration date
11/08/2007
Last updated
11/08/2007
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