Provider Demographics
NPI:1639299746
Name:DIXON SOCIAL INTERACTIVE SERVICES INC.
Entity Type:Organization
Organization Name:DIXON SOCIAL INTERACTIVE SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:DERRIA
Authorized Official - Middle Name:NOLEN
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-258-8946
Mailing Address - Street 1:2105 KING LEAR CT
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-8504
Mailing Address - Country:US
Mailing Address - Phone:252-258-8946
Mailing Address - Fax:
Practice Address - Street 1:3010 TRENT RD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-5735
Practice Address - Country:US
Practice Address - Phone:252-353-0100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8300651Medicaid