Lee Anne Anne Dickerson, LCP

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PSY004236 Issued in GA

Practice address

555 Sun Valley Dr Ste L1
Roswell, GA 30076-5630

Phone

(404) 394-1096

Fax

(404) 990-3531

NPI assigned

Aug 28, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other names 1

• Dr. Lee Anne Vaughan Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jan 25, 2024 through Jan 25, 2028

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Arbor Cove Therapy LLC

  • Clinical Social Worker
  • Roswell, GA
  • NPI 1720531767
  NPD
• Eden Counseling Center

  • Mental Health Counselor
  • Norfolk, VA
  • NPI 1801906144
  NPD (past)
• Genesis Counseling Center, Inc.

  • Professional Counselor
  • Hampton, VA
  • NPI 1164451399

  Clinical

  NPD (past)

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

{
    "created_epoch": "1156723200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706140800000",
    "number": "1184732307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "885 WOODSTOCK ROAD, SUITE 430",
            "address_2": "#515",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300752275",
            "telephone_number": "757-619-6859"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 SUN VALLEY DR STE L1",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300765630",
            "telephone_number": "404-394-1096",
            "fax_number": "404-990-3531"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICKERSON",
        "first_name": "LEE ANNE",
        "middle_name": "ANNE",
        "name_prefix": "Dr.",
        "credential": "LCP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-28",
        "last_updated": "2024-01-25",
        "certification_date": "2024-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "VA",
            "license": "810003264",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "VA",
            "license": "0810003264",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "GA",
            "license": "PSY004236",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LEE",
            "last_name": "VAUGHAN",
            "middle_name": "ANNE",
            "prefix": "DR.",
            "credential": "PSY.D./LPC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Rebecca Diamond
• Rena Diamond, MS, APC, NCC, CCH
• Joanne Renee Dibenedetto, CCC-SLP
• John Michael Dicarlo, M.D.
• David Lester Dickensheets, M.D.
• Amy Melinna Dickey, BCBA
• Rebecca Dideum, MT-BC
• Shelley Diefenbach, M.A.
• Deedee T Diep, D.O.
• John Michael Dierkes, DDS MS FICCMO

• Psychologist in Roswell, GA
• Providers in Roswell, GA by specialty
• Psychologist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.