Provider Demographics
NPI:1376741777
Name:DIXON, TABRINA LA SHAWN (LPC)
Entity Type:Individual
Prefix:
First Name:TABRINA
Middle Name:LA SHAWN
Last Name:DIXON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:TABRINA
Other - Middle Name:LA SHAWN
Other - Last Name:RIEVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:PO BOX 972843
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-0848
Mailing Address - Country:US
Mailing Address - Phone:734-649-8263
Mailing Address - Fax:
Practice Address - Street 1:302 N HURON ST
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-2947
Practice Address - Country:US
Practice Address - Phone:734-649-8263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-06
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401007811101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional