Provider Demographics
NPI:1487895900
Name:DICKSON, AMY NICOLE (LCSW)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:NICOLE
Last Name:DICKSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:NICOLE
Other - Last Name:FRELIGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1500 CRESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-4838
Mailing Address - Country:US
Mailing Address - Phone:870-926-5710
Mailing Address - Fax:
Practice Address - Street 1:1500 CRESTVIEW DR
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-4838
Practice Address - Country:US
Practice Address - Phone:870-926-5710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-12
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
AR7350-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator