Provider Demographics
NPI:1619532082
Name:DIXON, DESYREE ALLISON (LCSW-C)
Entity Type:Individual
Prefix:
First Name:DESYREE
Middle Name:ALLISON
Last Name:DIXON
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1534 BOLTON ST STE 1
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21217-4203
Mailing Address - Country:US
Mailing Address - Phone:703-587-6738
Mailing Address - Fax:
Practice Address - Street 1:1534 BOLTON ST STE 1
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21217-4203
Practice Address - Country:US
Practice Address - Phone:703-587-6738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-01
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18764101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health