| Provider / Organization | NPI | Date Certified |
|---|---|---|
| LATREECE EVETTE DICKERSON | 1053409722 | 2023-11-10 |
Latreece E Dickerson [F] graduated in 1996 from Loyola University Of Chicago, Stritch School Of Medicine and primarily specializes in Psychologist, Clinical.
Latreece Evette Dickerson is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1053409722. Registration indicates Latreece Evette Dickerson is a provider of access to mental health/behavioral health providers services with a specialization in Behavioral Health & Social Service Providers, Social Worker (Behavioral Health & Social Service Providers, Social Worker) (Social Worker: Clinical, ) (Behavioral Health/Substance Abuse/Psychiatry, ) (Social Worker Clinical, Behavioral Health & Social Service Providers) (Social Worker, ) Access to Mental Health/Behavioral Health Providers (Behavioral Health & Social Service Providers, Psychologist) (Behavioral Health & Social Service Providers, Psychologist) (Psychologist: Clinical, ) (Behavioral Health/Substance Abuse/Psychiatry, ) (Psychologist Clinical, Behavioral Health & Social Service Providers) (Psychologist, )
| PECOS ID | 42445769 |
| Registration | PART-B:Y DME:Y HHA:N PMD:N |
| Entity Type | Individual |
| Provider Name | Dr. Latreece Evette Dickerson PSY.D. |
| Practice Office Address | 9933 S WESTERN AVE STE 203 CHICAGO, IL US |
| Practice Office Telephone | 3127303966 |
| Practice Office Fax | 3128031635 |
| Mailing Address | 9933 S WESTERN AVE STE 203 CHICAGO, IL 606431810 US |
| Business Telephone | 3127303966 |
| Business Fax | 3128031635 |
| Address | City / State | Phone / Fax |
|---|---|---|
| 7230 S Fairfield Avenue | Chicago, IL 60629 | 7734402248 |
| Code | Practice | License No State |
|---|---|---|
| 1041C0700X | Access to Mental Health/Behavioral Health Providers Behavioral Health & Social Service Providers Social Worker Behavioral Health & Social Service Providers Social Worker Social Worker: Clinical Behavioral Health/Substance Abuse/Psychiatry Social Worker Clinical Behavioral Health & Social Service Providers Social Worker | 149-008520
IL |
| 103TC0700X PRIMARY | Access to Mental Health/Behavioral Health Providers Behavioral Health & Social Service Providers Psychologist Behavioral Health & Social Service Providers Psychologist Psychologist: Clinical Behavioral Health/Substance Abuse/Psychiatry Psychologist Clinical Behavioral Health & Social Service Providers Psychologist | 071009102
IL |
| 1437667805 | OTHER | IL | PARTNERSHIPS IN |