Individual
RENEE DICKERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCPC, CADC
Contact information
Practice address
9633 S PEORIA ST, CHICAGO, IL 60643-1515
(773) 715-1613
Mailing address
9633 S PEORIA ST, CHICAGO, IL 60643-1515
(773) 715-1613
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
180004504
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
920571231
—
IL
Enumeration date
11/03/2022
Last updated
11/03/2022
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