Provider Demographics
NPI:1760232664
Name:DIXSON, VIRRONICA N (MFT)
Entity Type:Individual
Prefix:MRS
First Name:VIRRONICA
Middle Name:N
Last Name:DIXSON
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 NORTH DR
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-4158
Mailing Address - Country:US
Mailing Address - Phone:716-430-5105
Mailing Address - Fax:
Practice Address - Street 1:5872 MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5710
Practice Address - Country:US
Practice Address - Phone:716-931-9037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP118961106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist