Provider Demographics
NPI:1619204146
Name:DIXON, STEPHANIE ORLENA (LCSW, LCAS)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:ORLENA
Last Name:DIXON
Suffix:
Gender:F
Credentials:LCSW, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 HYDRANGEA CIR NW
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-7240
Mailing Address - Country:US
Mailing Address - Phone:980-585-9052
Mailing Address - Fax:
Practice Address - Street 1:232 HYDRANGEA CIR NW
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-7240
Practice Address - Country:US
Practice Address - Phone:980-585-9052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-04
Last Update Date:2022-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-25972101YA0400X
NCC0133231041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)