Provider Demographics
NPI:1124403167
Name:DIXON, CHARLES (MA)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
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 1:1153 CORAL FARMS RD
Mailing Address - Street 2:BOX 583
Mailing Address - City:FLORAHOME
Mailing Address - State:FL
Mailing Address - Zip Code:32140-0583
Mailing Address - Country:US
Mailing Address - Phone:386-972-6018
Mailing Address - Fax:
Practice Address - Street 1:4300 SW 13TH ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-4006
Practice Address - Country:US
Practice Address - Phone:352-374-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-20
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)