Active NPI
Anne Godfrey Dickerson, LPC
- Professional Counselor
- Charlotte, NC
National Provider Identifier
1386895415
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 4412
- Practice address
- 4950 Park Rd
Charlotte, NC 28209-3506 - Phone
- (704) 523-4881
- Fax
- (704) 523-4854
- NPI assigned
- Oct 7, 2008
- 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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 4412 | NC | Primary |
Addresses
Primary practice location
4950 Park Rd
Charlotte, NC 28209-3506
Mailing address
4950 Park Rd
Charlotte, NC 28209-3506
Phone (704) 523-4881
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4412 | NC | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1223337600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1280102400000",
"number": "1386895415",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4950 PARK RD",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282093506",
"telephone_number": "704-523-4881",
"fax_number": "704-523-4854"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4950 PARK RD",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282093506",
"telephone_number": "704-523-4881",
"fax_number": "704-523-4854"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DICKERSON",
"first_name": "ANNE",
"middle_name": "GODFREY",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-10-07",
"last_updated": "2010-07-26",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "NC",
"license": "4412",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Charlotte, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.