Provider Demographics
NPI:1265848147
Name:DIXON, BRIANA MARIE (MA, LPC, CAADP)
Entity Type:Individual
Prefix:
First Name:BRIANA
Middle Name:MARIE
Last Name:DIXON
Suffix:
Gender:F
Credentials:MA, LPC, CAADP
Other - Prefix:
Other - First Name:BRIANA
Other - Middle Name:MARIE
Other - Last Name:MEARS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:521 STATE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-1369
Mailing Address - Country:US
Mailing Address - Phone:269-408-6031
Mailing Address - Fax:269-593-5988
Practice Address - Street 1:521 STATE ST
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-1369
Practice Address - Country:US
Practice Address - Phone:269-408-6031
Practice Address - Fax:269-593-5988
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-11
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401014597101YP2500X
TX332995101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty