Provider Information for 1366044653
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RANDIA MARIE DICKERSON LMSW
Sex: Female
NPI: 1366044653
Last Updated: 2024-05-07
Certification Date: 2024-05-07
Certification Date: 2024-05-07
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1366044653 | ||||||||
| Enumeration Date | 2020-11-11 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 2925 RUSSELL ST DETROIT, MI 48207-4825 United States Phone: 313-500-1262 | Fax: | ||||||||
| Primary Practice Address | 2925 RUSSELL ST DETROIT, MI 48207-4825 United States Phone: 313-500-1262 | Fax: | ||||||||
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