Individual
ELVIS W DICKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
10904 E SEBRING AVE, MESA, AZ 85212-5229
(480) 399-3727
Mailing address
10904 E SEBRING AVE, MESA, AZ 85212-5229
(480) 399-3727
Taxonomy
Speciality
Code
Description
License number
State
253J00000X
Foster Care Agency
Primary
812921961A1
AZ
Other
Enumeration date
10/24/2020
Last updated
04/20/2023
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