Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | KY |
NPI | 1003405333 |
---|---|
Provider Name | Holly L Dickison |
First Address | Lexington, KY 40511-1275 |
Second Address | Lexington, KY 40511-1275 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2021 |
Last Update Date | 12/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1790731081 | (05) | KY |