Katherine Ruth Dickerson, LCMHCS, LCAS, CCS

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

S9956 Issued in NC

Practice address

7490 Waterside Crossing Blvd Ste 2a
Denver, NC 28037-3004

Phone

(704) 360-3637

Fax

(704) 625-9789

NPI assigned

Aug 11, 2009

Last updated

Dec 15, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 1

Other names 1

• Katherine R Pedraza Former name

Medicare fee-for-service enrollment

Enrolled in NC

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

Interoperability endpoints

• Direct secure messaging: integrativewellnesssolutions.katherinedickerson@146232.advancedmd-direct.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Integrative Wellness Solutions, PLLC

  dba LifeStance Health

  • Psychologist
  • Mooresville, NC
  • NPI 1447760871
  Medicare reassignment

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

{
    "created_epoch": "1249948800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702598400000",
    "number": "1780816603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7490 WATERSIDE CROSSING BLVD STE 2A",
            "city": "DENVER",
            "state": "NC",
            "postal_code": "280373004",
            "telephone_number": "704-360-3637",
            "fax_number": "704-625-9789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7490 WATERSIDE CROSSING BLVD STE 2A",
            "city": "DENVER",
            "state": "NC",
            "postal_code": "280373004",
            "telephone_number": "704-360-3637",
            "fax_number": "704-625-9789"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "122 Gateway Blvd Ste C",
            "address_purpose": "LOCATION",
            "city": "Mooresville",
            "state": "NC",
            "postal_code": "281175544",
            "country_code": "US",
            "telephone_number": "704-360-3637",
            "fax_number": "704-200-9829",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DICKERSON",
        "first_name": "KATHERINE",
        "middle_name": "RUTH",
        "credential": "LCMHCS, LCAS, CCS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-08-11",
        "last_updated": "2023-12-15",
        "certification_date": "2023-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "LCAS-1406",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "CCS-10965",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "CCS-10965",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "S9956",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3112086",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATHERINE",
            "last_name": "PEDRAZA",
            "middle_name": "R",
            "credential": "MS, LCAS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Denver Family Practice, PLLC
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• Denver Pharmacy
• Denver Phcy of Lincoln Cnty Inc (Denver Pharmacy)
• Amrita Kaur Dhillon, MD
• Deanna Marie Didiano, DO
• Dr Shanyn & Associates PC (Care Counseling Center)
• Driftwood Yoga, Spa & Boutique, Inc.
• Early Learning Interventions LLC
• Kristen L Eberhardt

• Mental Health Counselor in Denver, NC
• Providers in Denver, NC by specialty
• Mental Health Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2023; 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.