Provider Demographics
NPI:1104078104
Name:DIXON, LAKISHA K (PLMSW)
Entity type:Individual
Prefix:
First Name:LAKISHA
Middle Name:K
Last Name:DIXON
Suffix:
Gender:F
Credentials:PLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 E OAK ST STE 1
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-4644
Mailing Address - Country:US
Mailing Address - Phone:501-336-0511
Mailing Address - Fax:501-336-4037
Practice Address - Street 1:2215 E OAK ST STE 1
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-4644
Practice Address - Country:US
Practice Address - Phone:501-336-0511
Practice Address - Fax:501-336-4037
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPLMSW104100000X
AR2693-B1041C0700X
AR171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR170674795Medicaid