Provider Demographics
NPI:1679940597
Name:DICKERSON, JACOB (LPC, RPT)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:DICKERSON
Suffix:
Gender:M
Credentials:LPC, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7232 HIGHWAY 7
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:AR
Mailing Address - Zip Code:71929-7105
Mailing Address - Country:US
Mailing Address - Phone:501-627-2503
Mailing Address - Fax:501-222-1282
Practice Address - Street 1:100 RIDGEWAY ST STE 1
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-7155
Practice Address - Country:US
Practice Address - Phone:501-627-2503
Practice Address - Fax:501-222-1282
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-26
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA1704202101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health