Organization
PHYLLIS L DICKERSON LCSW
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PHYLLIS L DICKERSON LCSW (OWNER)
(228) 331-3310
Entity
Organization
Contact information
Practice address
8990 LORRAINE RD, GULFPORT, MS 39503-4176
(228) 331-3310
Mailing address
8990 LORRAINE RD, GULFPORT, MS 39503-4176
(228) 331-3310
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C5893
MS
Other
Enumeration date
06/30/2017
Last updated
07/21/2022
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