Provider Demographics
NPI:1760411755
Name:POWELL DIXON, GWENDOLYN (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:GWENDOLYN
Middle Name:
Last Name:POWELL DIXON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7779 THORNHILL DR
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-6149
Mailing Address - Country:US
Mailing Address - Phone:734-635-1527
Mailing Address - Fax:
Practice Address - Street 1:7779 THORNHILL DR
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-6149
Practice Address - Country:US
Practice Address - Phone:734-635-1527
Practice Address - Fax:734-635-1527
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-01
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010618601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOP33860Medicare ID - Type Unspecified