Provider Demographics
NPI:1336628650
Name:DIXON, STEPHANIE BRIONNA (LMSW)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:BRIONNA
Last Name:DIXON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42483 CLINTON PLACE DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1634
Mailing Address - Country:US
Mailing Address - Phone:248-671-3349
Mailing Address - Fax:
Practice Address - Street 1:42483 CLINTON PLACE DR
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-1634
Practice Address - Country:US
Practice Address - Phone:313-467-4293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-08
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011139281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical