Provider Demographics
NPI:1295439701
Name:DIXON, JAMES RODNEY
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:RODNEY
Last Name:DIXON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2711 30TH ST SE APT B185
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-3136
Mailing Address - Country:US
Mailing Address - Phone:202-905-8176
Mailing Address - Fax:
Practice Address - Street 1:2711 30TH ST SE APT B185
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-3136
Practice Address - Country:US
Practice Address - Phone:202-905-8176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC376J00000X, 103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
No376J00000XNursing Service Related ProvidersHomemaker