Provider Demographics
NPI:1639624646
Name:DIXON, JAMES (MED, MS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:DIXON
Suffix:
Gender:M
Credentials:MED, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17255 SANTA FE ST
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-1055
Mailing Address - Country:US
Mailing Address - Phone:415-632-9976
Mailing Address - Fax:
Practice Address - Street 1:17255 SANTA FE ST
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-1055
Practice Address - Country:US
Practice Address - Phone:415-632-9976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-19
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X, 101YM0800X
CAR1333270119101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No172V00000XOther Service ProvidersCommunity Health Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health