Provider Demographics
NPI:1760811103
Name:DIXON FAMILY COUNSELING, INC
Entity Type:Organization
Organization Name:DIXON FAMILY COUNSELING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARTI
Authorized Official - Middle Name:MILLIKEN
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, PCC-S
Authorized Official - Phone:440-417-0006
Mailing Address - Street 1:15 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:OH
Mailing Address - Zip Code:44057-3125
Mailing Address - Country:US
Mailing Address - Phone:440-417-0006
Mailing Address - Fax:440-417-0006
Practice Address - Street 1:15 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:OH
Practice Address - Zip Code:44057-3125
Practice Address - Country:US
Practice Address - Phone:440-417-0006
Practice Address - Fax:440-417-0006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-06
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0008441101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHE0008441OtherSTATE