Provider Demographics
NPI:1205486511
Name:DIXON, ERIONIA (MS, LPC 7620-125)
Entity type:Individual
Prefix:
First Name:ERIONIA
Middle Name:
Last Name:DIXON
Suffix:
Gender:F
Credentials:MS, LPC 7620-125
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6737 W WASHINGTON ST STE 2275
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53214-5666
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6737 W WASHINGTON ST STE 2275
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53214-5666
Practice Address - Country:US
Practice Address - Phone:414-246-2300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-18
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3861101YP2500X
WI7620101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI7620-125OtherLICENSED PROFESSIONAL COUNSELOR