Benjain Patrick Dickerson

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LAC-22436 Issued in AZ

Practice address

21448 N 75TH Ave Ste 6
Glendale, AZ 85308-5978

Phone

(602) 697-5485

NPI assigned

Oct 1, 2025

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Ben P Dickerson Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1759276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759276800000",
    "number": "1376417469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 E MAIL TRAIL RD",
            "city": "YOUNG",
            "state": "AZ",
            "postal_code": "855540689",
            "telephone_number": "602-697-5485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21448 N 75TH AVE STE 6",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853085978",
            "telephone_number": "602-697-5485"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8700 E Vista Bonita Dr Ste 236",
            "address_purpose": "LOCATION",
            "city": "Scottsdale",
            "state": "AZ",
            "postal_code": "852553202",
            "country_code": "US",
            "telephone_number": "602-697-5485",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DICKERSON",
        "first_name": "BENJAIN",
        "middle_name": "PATRICK",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-10-01",
        "last_updated": "2025-10-01",
        "certification_date": "2025-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "AZ",
            "license": "LAC-22436",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BEN",
            "last_name": "DICKERSON",
            "middle_name": "P",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Cassandra Beth Diaz de Leon, DNP, PMHNP-BC
• Jose Yadiel Diaz Molina, MD
• Anna Diaz, LAMFT
• Carolina Diaz, RBT
• Lizete Diaz, PMHNP
• Kadi Dickey, LMT
• Kurt Farr Dickson, MD
• Wendy Sue Diederich
• Bernadette Roseanne Diegnan, D.O.
• Allison Michelle Diehl, MD

• Professional Counselor in Glendale, AZ
• Providers in Glendale, AZ by specialty
• Professional Counselor in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.