Provider Demographics
NPI:1730885070
Name:DICKSON, AMBER MARIE (CDCA)
Entity type:Individual
Prefix:MISS
First Name:AMBER
Middle Name:MARIE
Last Name:DICKSON
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1443 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44307-1252
Mailing Address - Country:US
Mailing Address - Phone:234-204-6336
Mailing Address - Fax:
Practice Address - Street 1:1443 EAST AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44307-1252
Practice Address - Country:US
Practice Address - Phone:234-204-6336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.181998101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)