Provider Demographics
NPI:1477960300
Name:DEAN, DEA DIXON (LMFTA)
Entity Type:Individual
Prefix:
First Name:DEA
Middle Name:DIXON
Last Name:DEAN
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5317 FAIRWAY ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-4258
Mailing Address - Country:US
Mailing Address - Phone:601-724-5040
Mailing Address - Fax:601-724-5040
Practice Address - Street 1:5422 CLINTON BLVD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39209-3004
Practice Address - Country:US
Practice Address - Phone:601-724-5040
Practice Address - Fax:601-724-5040
Is Sole Proprietor?:No
Enumeration Date:2014-07-11
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST0480A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist