Provider Demographics
NPI:1083882625
Name:DIXON, LUEVA (MSW)
Entity Type:Individual
Prefix:MS
First Name:LUEVA
Middle Name:
Last Name:DIXON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MRS
Other - First Name:LUEVA
Other - Middle Name:DIXON
Other - Last Name:LERNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW
Mailing Address - Street 1:590 WALLACE ST
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-1605
Mailing Address - Country:US
Mailing Address - Phone:248-540-7217
Mailing Address - Fax:248-593-5756
Practice Address - Street 1:950 E MAPLE RD
Practice Address - Street 2:SUITE 214
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-6408
Practice Address - Country:US
Practice Address - Phone:248-540-0060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-18
Last Update Date:2008-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010154111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI8008973490OtherBLUE CROSS/BLUE SHIELD