Provider Demographics
NPI:1235952086
Name:DICKISON, HEATHER (AMFT)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:DICKISON
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11187 WESTSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:FORESTVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95436-9736
Mailing Address - Country:US
Mailing Address - Phone:510-517-9799
Mailing Address - Fax:
Practice Address - Street 1:2255 CHALLENGER WAY
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95407-5423
Practice Address - Country:US
Practice Address - Phone:707-565-6449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-31
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist