Provider Demographics
NPI:1053170373
Name:DICKERSON, VALERIE (MS, RD, LDN, CDCES)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:
Last Name:DICKERSON
Suffix:
Gender:F
Credentials:MS, RD, LDN, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 MUIRFIELD DR
Mailing Address - Street 2:
Mailing Address - City:YOUNGSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27596-2016
Mailing Address - Country:US
Mailing Address - Phone:919-280-0412
Mailing Address - Fax:
Practice Address - Street 1:175 MUIRFIELD DR
Practice Address - Street 2:
Practice Address - City:YOUNGSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27596-2016
Practice Address - Country:US
Practice Address - Phone:919-280-0412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL003804133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered