Provider Demographics
NPI:1275203069
Name:BRIANNA DIXON, LLPC, PLLC
Entity Type:Organization
Organization Name:BRIANNA DIXON, LLPC, PLLC
Other - Org Name:RISING LIGHT THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:BRIANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:810-379-0212
Mailing Address - Street 1:805 S STATE RD # 182
Mailing Address - Street 2:
Mailing Address - City:DAVISON
Mailing Address - State:MI
Mailing Address - Zip Code:48423-1751
Mailing Address - Country:US
Mailing Address - Phone:810-379-0212
Mailing Address - Fax:
Practice Address - Street 1:805 S STATE RD # 182
Practice Address - Street 2:
Practice Address - City:DAVISON
Practice Address - State:MI
Practice Address - Zip Code:48423-1751
Practice Address - Country:US
Practice Address - Phone:810-379-0212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-14
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1932574902Medicaid