Provider Demographics
NPI:1619320884
Name:DIXON, CARLA MCMANUS (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:MCMANUS
Last Name:DIXON
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 W MARIETTA ST NW
Mailing Address - Street 2:#1325
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-5293
Mailing Address - Country:US
Mailing Address - Phone:404-520-0071
Mailing Address - Fax:
Practice Address - Street 1:2400 HERODIAN WAY SE
Practice Address - Street 2:SUITE 220
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-8581
Practice Address - Country:US
Practice Address - Phone:404-520-0071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-22
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC008476101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA101YP2500XMedicaid