Provider Demographics
NPI:1083389936
Name:DIXON, DEKHARI JOSIAH LIEHL (MA)
Entity Type:Individual
Prefix:
First Name:DEKHARI
Middle Name:JOSIAH LIEHL
Last Name:DIXON
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3731 W CONCORD PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-4707
Mailing Address - Country:US
Mailing Address - Phone:832-998-9292
Mailing Address - Fax:
Practice Address - Street 1:3046 W ARMITAGE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-5935
Practice Address - Country:US
Practice Address - Phone:318-547-1823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health