Provider Demographics
NPI:1619176930
Name:DIXON, TA'NISHIA JONES (MS)
Entity Type:Individual
Prefix:
First Name:TA'NISHIA
Middle Name:JONES
Last Name:DIXON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:TA'NISHIA
Other - Middle Name:LASHELLE
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS LMFT
Mailing Address - Street 1:2902 LITTLE GEM CIR
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-7872
Mailing Address - Country:US
Mailing Address - Phone:252-215-0589
Mailing Address - Fax:
Practice Address - Street 1:2902 LITTLE GEM CIR
Practice Address - Street 2:
Practice Address - City:WINTERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28590-7872
Practice Address - Country:US
Practice Address - Phone:252-215-0589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1090106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist