Provider Demographics
NPI:1801412382
Name:MIXON, DASHAWN SHEREE
Entity Type:Individual
Prefix:
First Name:DASHAWN
Middle Name:SHEREE
Last Name:MIXON
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 1:3646 MOUNT ELLIOTT ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48207-2311
Mailing Address - Country:US
Mailing Address - Phone:313-335-2310
Mailing Address - Fax:
Practice Address - Street 1:3646 MOUNT ELLIOTT ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-2311
Practice Address - Country:US
Practice Address - Phone:313-335-2310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-22
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker