Provider Demographics
NPI:1215595186
Name:DIXON-OLIVARES, MESHAI (APC)
Entity Type:Individual
Prefix:
First Name:MESHAI
Middle Name:
Last Name:DIXON-OLIVARES
Suffix:
Gender:F
Credentials:APC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4158 VALLEY DR SW
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-4052
Mailing Address - Country:US
Mailing Address - Phone:678-677-0295
Mailing Address - Fax:
Practice Address - Street 1:1039 GRANT ST SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30315-2014
Practice Address - Country:US
Practice Address - Phone:478-215-2304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-04
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC006759101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health