Provider Demographics
NPI:1710251301
Name:DIXON HATHCOCK, KAREN (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:
Last Name:DIXON HATHCOCK
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MS
Other - First Name:KAREN
Other - Middle Name:MARIE
Other - Last Name:DIXON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:6002 FILLYSIDE TRL
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-1879
Mailing Address - Country:US
Mailing Address - Phone:904-314-3380
Mailing Address - Fax:904-731-9639
Practice Address - Street 1:6810 SAINT AUGUSTINE RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-2818
Practice Address - Country:US
Practice Address - Phone:904-731-0441
Practice Address - Fax:904-731-9639
Is Sole Proprietor?:No
Enumeration Date:2012-02-29
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7786101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health