Phyllis L Dickerson LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C5893 Issued in MS

Legal business name

PHYLLIS L DICKERSON LCSW

Practice address

8990 Lorraine Rd
Gulfport, MS 39503-4176

Phone

(228) 331-3310

NPI assigned

Jun 30, 2017

Last updated

Jul 21, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Phyllis L Dickerson, LCSWNPI 1114204807

Title

Owner

Phone

(228) 331-3310

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Phyllis L Dickerson, LCSW

  • Clinical Social Worker
  • Gulfport, MS
  • NPI 1114204807
  NPD Authorized official

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

{
    "created_epoch": "1498780800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1750802534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8990 LORRAINE RD",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395034176",
            "telephone_number": "228-331-3310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8990 LORRAINE RD",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395034176",
            "telephone_number": "228-331-3310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYLLIS L DICKERSON LCSW",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-30",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "DICKERSON",
        "authorized_official_first_name": "PHYLLIS",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "228-331-3310",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MS",
            "license": "C5893",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah Elizabeth Phillips, MS, MD
• Phoenix Clinical Labs Inc
• Phoenix Independent Living
• Phoenix Independent Living Inc
• Phoenix Independent Living Inc
• Physical Therapy Clinic of Gulfport
• Physicians Care Plaza, LLC
• Physicians Pain and Spine Specialists
• Christopher Scott Pickreign
• Gregory Kevin Picou, D.C.

• Clinical Social Worker in Gulfport, MS
• Providers in Gulfport, MS by specialty
• Clinical Social Worker in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.