Provider Demographics
NPI:1790551646
Name:DIXON, LAURA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:DIXON
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 1:323 HEMLOCK CIR
Mailing Address - Street 2:
Mailing Address - City:TERRA ALTA
Mailing Address - State:WV
Mailing Address - Zip Code:26764-2644
Mailing Address - Country:US
Mailing Address - Phone:214-676-7388
Mailing Address - Fax:
Practice Address - Street 1:1515 RISING RIDGE RD
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:MD
Practice Address - Zip Code:21771-5383
Practice Address - Country:US
Practice Address - Phone:240-668-4415
Practice Address - Fax:240-673-6332
Is Sole Proprietor?:No
Enumeration Date:2023-12-01
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician