Kelly Nicole Dickerson, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

CSW007086 Issued in GA

Practice address

204 W Spring St
Monroe, GA 30655-1914

Phone

(770) 599-7508

Fax

(866) 734-7631

NPI assigned

May 27, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Kelly Jackson Dickerson Former name

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Creative Center for Wellness, IncorporatedGroup PAC ID 3274888946, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Creative Center for Wellness, Incorporated

  • Clinical Social Worker
  • Monroe, GA
  • NPI 1154837946
  Medicare reassignment Care Compare group NPD
• Southeastern Psychological Associates, Inc

  • Clinical Child & Adolescent Psychologist
  • Covington, GA
  • NPI 1316216880
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1590537600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722384000000",
    "number": "1003439928",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 W SPRING ST",
            "city": "MONROE",
            "state": "GA",
            "postal_code": "306551914",
            "telephone_number": "770-599-7508",
            "fax_number": "866-734-7631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 W SPRING ST",
            "city": "MONROE",
            "state": "GA",
            "postal_code": "306551914",
            "telephone_number": "770-599-7508",
            "fax_number": "866-734-7631"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICKERSON",
        "first_name": "KELLY",
        "middle_name": "NICOLE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-05-27",
        "last_updated": "2024-07-31",
        "certification_date": "2024-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "GA",
            "license": "CSW007086",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "JACKSON DICKERSON",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• William Donovan Delp, D.O.
• Destiney Dempsey, LMSW
• Joe H Dew, OD
• Susan Elizabeth Dexter, NURSE PRACTITIONER
• Natasha A Dhannani
• Divine 5 Services LLP
• Divine 5 Services, LLC
• Valerie Paige Doebrick Wilkinson, L.M.T.
• Maggie Dotson, NP
• Kayla S Dowling, DC

• Clinical Social Worker in Monroe, GA
• Providers in Monroe, GA by specialty
• Clinical Social Worker in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.