Provider Demographics
NPI:1669833059
Name:DIXIE, CHERISE
Entity Type:Individual
Prefix:
First Name:CHERISE
Middle Name:
Last Name:DIXIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 BROADWAY STE 350
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46802-1412
Mailing Address - Country:US
Mailing Address - Phone:260-423-2675
Mailing Address - Fax:260-423-6621
Practice Address - Street 1:750 BROADWAY STE 350
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46802-1412
Practice Address - Country:US
Practice Address - Phone:260-423-2675
Practice Address - Fax:260-423-6621
Is Sole Proprietor?:No
Enumeration Date:2016-03-11
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34007141A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical