Provider Demographics
NPI:1922180025
Name:DIXON, LISELOTTE ANNEMARIE (MFT)
Entity Type:Individual
Prefix:MRS
First Name:LISELOTTE
Middle Name:ANNEMARIE
Last Name:DIXON
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MRS
Other - First Name:LILO
Other - Middle Name:
Other - Last Name:DIXON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:250 BEL MARIN KEYS BLVD C5
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94949
Mailing Address - Country:US
Mailing Address - Phone:415-883-7652
Mailing Address - Fax:415-897-8160
Practice Address - Street 1:250 BEL MARIN KEYS BLVD C5
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94949
Practice Address - Country:US
Practice Address - Phone:415-883-7652
Practice Address - Fax:415-897-8160
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19998106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist