Provider Demographics
NPI:1568987162
Name:STEPHEN AND INA DIXON WELLNESS CENTER
Entity Type:Organization
Organization Name:STEPHEN AND INA DIXON WELLNESS CENTER
Other - Org Name:STEPHEN AND INA DIXON WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NAKIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:BTECH
Authorized Official - Phone:832-766-3048
Mailing Address - Street 1:1111 MCILHENNY ST STE 28
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77002-9141
Mailing Address - Country:US
Mailing Address - Phone:832-766-3048
Mailing Address - Fax:832-831-1377
Practice Address - Street 1:1111 MCILHENNY ST STE 28
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-9141
Practice Address - Country:US
Practice Address - Phone:832-766-3048
Practice Address - Fax:832-831-1377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-04
Last Update Date:2017-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services