Provider Demographics
NPI:1396901799
Name:DIXON, MELISSA LEIGH (MA, BCBA, LBA)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:LEIGH
Last Name:DIXON
Suffix:
Gender:F
Credentials:MA, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 BECKY BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-2704
Mailing Address - Country:US
Mailing Address - Phone:815-985-3882
Mailing Address - Fax:
Practice Address - Street 1:290 BECKY BRANCH RD
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-2704
Practice Address - Country:US
Practice Address - Phone:815-985-3882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-05
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
IL1-11-9409103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health