Provider Demographics
NPI:1487866869
Name:DIXON, LYNNE MARION (MFT)
Entity Type:Individual
Prefix:MS
First Name:LYNNE
Middle Name:MARION
Last Name:DIXON
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1939 DIVISADERO ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-2507
Mailing Address - Country:US
Mailing Address - Phone:415-346-4876
Mailing Address - Fax:415-507-9045
Practice Address - Street 1:1939 DIVISADERO ST
Practice Address - Street 2:SUITE 1
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-2507
Practice Address - Country:US
Practice Address - Phone:415-346-4876
Practice Address - Fax:415-507-9045
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22153106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist