Provider Demographics
NPI:1679643159
Name:DIX, TONYA SHIREE (LGSW)
Entity Type:Individual
Prefix:MS
First Name:TONYA
Middle Name:SHIREE
Last Name:DIX
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 249
Mailing Address - Street 2:
Mailing Address - City:SNOW HILL
Mailing Address - State:MD
Mailing Address - Zip Code:21863-0249
Mailing Address - Country:US
Mailing Address - Phone:410-632-4510
Mailing Address - Fax:
Practice Address - Street 1:422 W MARKET ST
Practice Address - Street 2:
Practice Address - City:SNOW HILL
Practice Address - State:MD
Practice Address - Zip Code:21863-1127
Practice Address - Country:US
Practice Address - Phone:410-632-4510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDG114561041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool