Provider Demographics
NPI:1417159120
Name:DIXON, HOLLY LYNN (LMSW-CC)
Entity Type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:LYNN
Last Name:DIXON
Suffix:
Gender:F
Credentials:LMSW-CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 103
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04937-0103
Mailing Address - Country:US
Mailing Address - Phone:207-314-7190
Mailing Address - Fax:207-287-4726
Practice Address - Street 1:75 MORRISON AVE
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:ME
Practice Address - Zip Code:04927
Practice Address - Country:US
Practice Address - Phone:207-426-2181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC10210104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker