Provider Demographics
NPI:1205313491
Name:DIXON, CIARA T (MS, LPC, NCC)
Entity type:Individual
Prefix:
First Name:CIARA
Middle Name:T
Last Name:DIXON
Suffix:
Gender:F
Credentials:MS, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 WESSEX CT
Mailing Address - Street 2:
Mailing Address - City:WENTZVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63385-4398
Mailing Address - Country:US
Mailing Address - Phone:314-649-7491
Mailing Address - Fax:855-674-1812
Practice Address - Street 1:71 WESSEX CT
Practice Address - Street 2:
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385-4398
Practice Address - Country:US
Practice Address - Phone:314-649-7491
Practice Address - Fax:855-674-1812
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-20
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018025908101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health