Provider Demographics
NPI:1003264367
Name:DIXON, BOBBIE (LLMSW)
Entity Type:Individual
Prefix:
First Name:BOBBIE
Middle Name:
Last Name:DIXON
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 E BIG BEAVER RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1905
Mailing Address - Country:US
Mailing Address - Phone:248-524-8801
Mailing Address - Fax:
Practice Address - Street 1:929 STEVENS ST
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48502-1620
Practice Address - Country:US
Practice Address - Phone:810-232-6081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-27
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801099424171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator