Provider Demographics
NPI:1558829994
Name:DIXON, ESTHER FREDRICA (LCAS-A)
Entity Type:Individual
Prefix:
First Name:ESTHER
Middle Name:FREDRICA
Last Name:DIXON
Suffix:
Gender:F
Credentials:LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 N SPRING ST
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101-2722
Mailing Address - Country:US
Mailing Address - Phone:336-631-1948
Mailing Address - Fax:
Practice Address - Street 1:326 N SPRING ST
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-2722
Practice Address - Country:US
Practice Address - Phone:336-631-1948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-05
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-24421101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)