Provider Demographics
NPI:1497527881
Name:HAMPTON-DIXON, JENNIFER (CADC-R)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:HAMPTON-DIXON
Suffix:
Gender:F
Credentials:CADC-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4213 DUBLIN RD
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-6809
Mailing Address - Country:US
Mailing Address - Phone:252-341-1764
Mailing Address - Fax:
Practice Address - Street 1:120 S ELM ST STE A
Practice Address - Street 2:
Practice Address - City:WILLIAMSTON
Practice Address - State:NC
Practice Address - Zip Code:27892-2304
Practice Address - Country:US
Practice Address - Phone:252-481-7552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-27
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCADC-21211101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)