Provider Demographics
NPI:1396393344
Name:DIXON, JAMIE L (CDCA, MBA)
Entity Type:Individual
Prefix:MR
First Name:JAMIE
Middle Name:L
Last Name:DIXON
Suffix:
Gender:M
Credentials:CDCA, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 SAINT JOHNS RD STE D
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45804-4029
Mailing Address - Country:US
Mailing Address - Phone:567-940-9145
Mailing Address - Fax:567-940-9803
Practice Address - Street 1:2727 SAINT JOHNS RD STE D
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45804-4029
Practice Address - Country:US
Practice Address - Phone:567-940-9145
Practice Address - Fax:567-940-9803
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-03
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.167571101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)