Provider Demographics
NPI:1154468379
Name:ELLINGER-DIXON, PAMELA S (PHD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:S
Last Name:ELLINGER-DIXON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3287 NORTHAMPTON LN
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-2702
Mailing Address - Country:US
Mailing Address - Phone:614-771-7736
Mailing Address - Fax:614-771-7736
Practice Address - Street 1:5001 HORIZONS DR STE 101
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-5291
Practice Address - Country:US
Practice Address - Phone:614-451-2599
Practice Address - Fax:614-771-7736
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4468103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling