Provider Demographics
NPI:1730634841
Name:POWERS, DIXIE FUNDERBURK
Entity Type:Individual
Prefix:
First Name:DIXIE
Middle Name:FUNDERBURK
Last Name:POWERS
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 1:2506 LAMBERT DR
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801-7237
Mailing Address - Country:US
Mailing Address - Phone:334-742-2700
Mailing Address - Fax:
Practice Address - Street 1:3170 MARTIN LUTHER KING JR PKWY S
Practice Address - Street 2:
Practice Address - City:PHENIX CITY
Practice Address - State:AL
Practice Address - Zip Code:36869-8405
Practice Address - Country:US
Practice Address - Phone:334-298-2405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-18
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3583101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health