Provider Demographics
NPI:1326506825
Name:DIXON, HANNAH CORNELIUS (PHD)
Entity Type:Individual
Prefix:DR
First Name:HANNAH
Middle Name:CORNELIUS
Last Name:DIXON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:MARIE
Other - Last Name:CORNELIUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8806 SHOSHONI TRL
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78255-2091
Mailing Address - Country:US
Mailing Address - Phone:361-701-4311
Mailing Address - Fax:
Practice Address - Street 1:8217 FREDERICKSBURG RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3355
Practice Address - Country:US
Practice Address - Phone:361-701-4311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-04
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX75434101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional