Provider Demographics
NPI:1528955663
Name:DICKINSON, KRISTINA MICHELLE
Entity type:Individual
Prefix:MS
First Name:KRISTINA
Middle Name:MICHELLE
Last Name:DICKINSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-4334
Mailing Address - Country:US
Mailing Address - Phone:318-855-0111
Mailing Address - Fax:318-855-0117
Practice Address - Street 1:1110 N 7TH ST
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-4334
Practice Address - Country:US
Practice Address - Phone:318-855-0111
Practice Address - Fax:318-855-0117
Is Sole Proprietor?:No
Enumeration Date:2025-06-20
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LACIT-5972101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)