KELLY JACKSON DICKERSON (NPI# 1003439928) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003439928 |
| Entity Type | Individual |
| Full Name | KELLY JACKSON DICKERSON |
| Other Name | KELLY MOOSE |
| Credential | LCSW |
| Practice Address |
3155 Mill St Ne Covington GA 30014-2542 |
| Practice Telephone | 6787126520 |
| Practice Fax Number | 6787126521 |
| Mailing Telephone | 6787126520 |
| Mailing Fax Number | 6787126521 |
| Enumeration Date | 2020-05-27 |
| Last Update Date | 2020-05-27 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1041C0700X |
Social Worker Specialization: Clinical |
CSW007086 | GA | Behavioral Health & Social Service Providers |
| Street Address |
3155 MILL ST NE |
| City | COVINGTON |
| State | GA |
| Zip Code | 30014-2542 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114082054 | Jessica Terry Morris | Counselor | 3155 Mill St Ne, Covington, GA 30014-2542 | 2006-12-22 |
| 1356994032 | Lauren E Clark | Social Worker | 3155 Mill St Ne, Covington, GA 30014-2542 | 2019-07-22 |
| 1205391919 | Samia Michelle Solaiman | Social Worker | 3155 Mill St Ne, Covington, GA 30014-2542 | 2019-02-06 |
| 1780158576 | Diane Foster Loffmin | Counselor | 3155 Mill St Ne, Covington, GA 30014-2542 | 2019-01-15 |
| 1821519174 | Stacia Frances Schmidt | Social Worker | 3155 Mill St Ne, Covington, GA 30014-2542 | 2017-06-27 |
| 1184150666 | Matthew Scott Henderson | Social Worker | 3155 Mill St Ne, Covington, GA 30014-2542 | 2017-05-03 |
| 1619414711 | Nena N Brown | Counselor | 3155 Mill St Ne, Covington, GA 30014-2542 | 2017-01-26 |
| 1740675198 | Suzanne Marie Griswold | Counselor | 3155 Mill St Ne, Covington, GA 30014-2542 | 2015-04-02 |
| 1255735106 | Sarah Davis | Psychologist | 3155 Mill St Ne, Covington, GA 30014-2542 | 2014-10-21 |
| 1790196582 | Cathrin Michaela Wilbanks | Counselor | 3155 Mill St Ne, Covington, GA 30014-2542 | 2014-05-14 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801495635 | Cathy Cassandra Collins | Pharmacist | 3639 Hwy 278, Covington, GA 30014 | 2020-10-22 |
| 1154933877 | Atl Optical LLC | Optometrist | 3135 Highway 278 Ne, Covington, GA 30014 | 2020-08-24 |
| 1932737046 | Samagas House Org | Adult Companion | 1500 Mountain View Cirlcle, Conyers, GA 30014 | 2020-04-01 |
| 1356834360 | Covington Dental Care | Dentist | 4139 Baker Street, Suite 15, Covington, GA 30014 | 2018-06-13 |
| 1487190005 | New Avenues Assessment and Counseling Center LLC | Counselor | 3192 Spring Street, Covington, NEWTON 30014 | 2017-01-07 |
| 1275903973 | Jennifer Carol Bridges | Registered Nurse | 320 Malcom Lane, Covington, GA 30014 | 2015-10-07 |
| 1134598501 | Shelby Boggus King | Physician Assistant | 4181 Hospital Drive Ne, Suite 204, Covington, GA 30014 | 2015-09-16 |
| 1366829814 | Wendy Pazdur | Counselor | 5109 Hwy 278 East, Suite D, Covington, GA 30014 | 2015-05-05 |
| 1306235445 | Covington Center for Family Dentistry | Dentist | 10373 Industrial Blvd, Covington, GA 30014 | 2015-01-13 |
| 1992103428 | Modern Cosmetic Dental Care, LLC | Clinic/Center | 1750 Highway 11, Suite B, Covington, GA 30014 | 2014-12-16 |
| Find all providers in zip 30014 | ||||
| Taxonomy Code | 1041C0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Social Worker |
| Specialization | Clinical |
| A social worker who holds a master’s or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master’s supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances. |
| Notes: Source: National Association of Social Workers, 2008 [7/1/2009: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144870817 | Catreshia Brundage | Social Worker | 40 Brighton Ridge Ln, Covington, GA 30016-6626 | 2019-09-16 |
| 1073010856 | Jennifer Rhea Dudley | Social Worker | 221 N Monroe Ave, Covington, VA 24426-1409 | 2018-04-09 |
| 1104369602 | Angela Webb Deem | Social Worker | 104 Sherry May St, Covington, VA 24426-6000 | 2016-12-01 |
| 1568904365 | Aundretta Wood | Social Worker | 200 Colser Dr, Covington, GA 30016-0991 | 2016-11-09 |
| 1538615596 | Chandrika Monique Derricho | Social Worker | 140 Cambridge Way, Covington, GA 30016-4943 | 2016-08-30 |
| 1023481447 | Abg LLC | Social Worker | 50 E Rivercenter Blvd, Suite 416, Covington, KY 41011-1683 | 2015-11-06 |
| 1932596673 | Dawn Gritten | Social Worker | 318 4th St Ste B, Covington, IN 47932-1275 | 2015-04-21 |
| 1104222454 | Melissa Patrick | Social Worker | 5108 Newton Dr Ne, Covington, GA 30014-2678 | 2014-11-14 |
| 1619376704 | Lawrence W Schwarz | Social Worker | 208 N Tyler St, Covington, LA 70433-1456 | 2014-08-14 |
| 1366858557 | Shannon Rebecca Russell | Social Worker | 434 Scott Blvd, Life Point Solutions, Covington, KY 41011 | 2014-07-08 |
| Find all providers in COVINGTON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.