Randia Marie Dickerson, LMSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

6801118110 Issued in MI

Practice address

2925 Russell St
Detroit, MI 48207-4825

Phone

(313) 500-1262

NPI assigned

Nov 11, 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

Medicare fee-for-service enrollment

Enrolled in MI

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

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.

• Team Wellness Center

  • Community Health Clinic/Center
  • Detroit, MI
  • NPI 1588855100
  Medicare reassignment NPD
• Team Mental Health Services Inc.

  • Primary Care Clinic/Center
  • Detroit, MI
  • NPI 1295324291
  NPD
• Team Mental Health Services Inc.

  • Dentist
  • Detroit, MI
  • NPI 1306383252
  NPD (past)

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

{
    "created_epoch": "1605052800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715040000000",
    "number": "1366044653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2925 RUSSELL ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482074825",
            "telephone_number": "313-500-1262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2925 RUSSELL ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482074825",
            "telephone_number": "313-500-1262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICKERSON",
        "first_name": "RANDIA",
        "middle_name": "MARIE",
        "credential": "LMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-11-11",
        "last_updated": "2024-05-07",
        "certification_date": "2024-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801118110",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeryn Dickerson
• Joya Dickerson
• Katila A Dickerson
• Kristina Dickerson, MSN
• Priscilla Dickerson
• Teasia Dickerson
• Tanesha Dickey
• Zenas C. Dickinson, M.D.
• Molly Elizabeth Dickson
• Sunitha Dida

• Clinical Social Worker in Detroit, MI
• Providers in Detroit, MI by specialty
• Clinical Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.