Provider Demographics
NPI:1467687988
Name:DIXON, RUBY JOHNE (LMHC)
Entity Type:Individual
Prefix:
First Name:RUBY
Middle Name:JOHNE
Last Name:DIXON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:RUBY
Other - Middle Name:JOHNE
Other - Last Name:POWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1420 SARASOTA DR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34759-4617
Mailing Address - Country:US
Mailing Address - Phone:561-716-4387
Mailing Address - Fax:
Practice Address - Street 1:1420 SARASOTA DR
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34759-4617
Practice Address - Country:US
Practice Address - Phone:561-716-4387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-28
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH10851101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL107238600Medicaid