Active NPI
Patricia Lavonne Dickerson, BA, AAC
- Mental Health Counselor
- Auburn, WA
National Provider Identifier
1043369507
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- CG60145655
- Practice address
- 4240 Auburn Way N
Auburn, WA 98002-1311 - Phone
- (253) 876-8900
- Fax
- (253) 876-8910
- NPI assigned
- Jan 10, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | CG60145655 | WA | Primary |
Addresses
Primary practice location
4240 Auburn Way N
Auburn, WA 98002-1311
Mailing address
1600 E Olive St
Sound Mental Health
Seattle, WA 98122-2735
Phone (206) 302-2200
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Bachelor of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CG60145655 | WA | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sound | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Tukwila, WA
- NPI 1780774950
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168387200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1482105600000",
"number": "1043369507",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1600 E OLIVE ST",
"address_2": "SOUND MENTAL HEALTH",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981222735",
"telephone_number": "206-302-2200",
"fax_number": "206-302-2210"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4240 AUBURN WAY N",
"city": "AUBURN",
"state": "WA",
"postal_code": "980021311",
"telephone_number": "253-876-8900",
"fax_number": "253-876-8910"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DICKERSON",
"first_name": "PATRICIA",
"middle_name": "LAVONNE",
"credential": "BA, AAC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-10",
"last_updated": "2016-12-19",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "WA",
"license": "CG60145655",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Auburn, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.