Provider Demographics
NPI:1689206765
Name:DIXON COUNSELING
Entity Type:Organization
Organization Name:DIXON COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:G
Authorized Official - Last Name:WENDOPHOL
Authorized Official - Suffix:I
Authorized Official - Credentials:MD
Authorized Official - Phone:708-401-7781
Mailing Address - Street 1:230 E MAIN ST STE 102
Mailing Address - Street 2:
Mailing Address - City:MORRISON
Mailing Address - State:IL
Mailing Address - Zip Code:61270-2802
Mailing Address - Country:US
Mailing Address - Phone:708-401-7781
Mailing Address - Fax:
Practice Address - Street 1:230 E MAIN ST STE 102
Practice Address - Street 2:
Practice Address - City:MORRISON
Practice Address - State:IL
Practice Address - Zip Code:61270-2802
Practice Address - Country:US
Practice Address - Phone:708-401-7781
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-06
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty