Individual
SHADE DICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1330 N BLACK HORSE PIKE, SUITE D, WILLIAMSTOWN, NJ 08094-9160
(856) 262-1200
Mailing address
1123 TARA DR, WILLIAMSTOWN, NJ 08094-3591
(856) 262-1200
(856) 262-1204
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
474254341
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
474254341
—
NJ
Enumeration date
06/22/2015
Last updated
06/22/2015
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