Provider Demographics
NPI:1689989162
Name:DIX, FLOYD DAVID (LCSW)
Entity Type:Individual
Prefix:MR
First Name:FLOYD
Middle Name:DAVID
Last Name:DIX
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8478 GARRITY WOODS LN
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:IN
Mailing Address - Zip Code:47274-8204
Mailing Address - Country:US
Mailing Address - Phone:812-345-1087
Mailing Address - Fax:
Practice Address - Street 1:438 S EMERSON AVE
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-1948
Practice Address - Country:US
Practice Address - Phone:317-859-2872
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-09
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34001107A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN34001107AOtherLICENSED CLINICAL SOCIAL WORKER