Provider Demographics
NPI:1033740139
Name:MONICA DICKENSON
Entity type:Organization
Organization Name:MONICA DICKENSON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:DICKENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-672-0680
Mailing Address - Street 1:231 GARRISONVILLE RD STE 201
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-1603
Mailing Address - Country:US
Mailing Address - Phone:703-672-0680
Mailing Address - Fax:
Practice Address - Street 1:231 GARRISONVILLE RD STE 201
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-1603
Practice Address - Country:US
Practice Address - Phone:703-672-0680
Practice Address - Fax:571-343-4327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-28
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies