Individual
THAD SHANE DICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CPHIMS, PMP
Contact information
Practice address
16511 34TH STREET KP N, LAKEBAY, WA 98349-9774
(253) 651-7482
Mailing address
16511 34TH STREET KP N, LAKEBAY, WA 98349-9774
(253) 651-7482
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
WA
246Z00000X
Other Specialist/Technologist
Primary
CPHIMS - 1592
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1592
CPHIMS
WA
01
—
451268
HCISSP
WA
01
—
DICKSTS PMP
PMP
WA
Enumeration date
06/23/2011
Last updated
05/07/2014
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