Provider Demographics
NPI:1376664326
Name:DICKERSON CHILDREN'S ADVOCACY CENTER
Entity type:Organization
Organization Name:DICKERSON CHILDREN'S ADVOCACY CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:FLAVIA
Authorized Official - Middle Name:BRENDA
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-CP
Authorized Official - Phone:803-849-5993
Mailing Address - Street 1:140 GIBSON ROAD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072
Mailing Address - Country:US
Mailing Address - Phone:803-358-7200
Mailing Address - Fax:803-358-7233
Practice Address - Street 1:140 GIBSON ROAD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072
Practice Address - Country:US
Practice Address - Phone:803-358-7200
Practice Address - Fax:803-358-7233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty