Provider Demographics
NPI:1205998010
Name:GEORGE, DIXIE L (MSW)
Entity type:Individual
Prefix:
First Name:DIXIE
Middle Name:L
Last Name:GEORGE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:DIXIE
Other - Middle Name:LYNN
Other - Last Name:HENDRICKS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1539
Mailing Address - Street 2:
Mailing Address - City:PROSSER
Mailing Address - State:WA
Mailing Address - Zip Code:99350-0833
Mailing Address - Country:US
Mailing Address - Phone:509-303-9947
Mailing Address - Fax:
Practice Address - Street 1:30 MERLOT DRIVE
Practice Address - Street 2:SUITE F
Practice Address - City:PROSSER
Practice Address - State:WA
Practice Address - Zip Code:99350
Practice Address - Country:US
Practice Address - Phone:509-303-9947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP 60010572101YA0400X
WALW60140442101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)