Provider Demographics
NPI:1245324854
Name:DIXON, REGINA BARTRAN (LMHC)
Entity type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:BARTRAN
Last Name:DIXON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 GARDEN GATE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504
Mailing Address - Country:US
Mailing Address - Phone:850-478-0008
Mailing Address - Fax:850-494-1817
Practice Address - Street 1:900 GARDEN GATE CIRCLE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504
Practice Address - Country:US
Practice Address - Phone:850-478-0008
Practice Address - Fax:850-494-1817
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8613101YM0800X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4642Medicaid
FLMH8613OtherLICENSE NUMBER