Provider Demographics
NPI:1457834533
Name:SANTIAGO, DIXIE RENEE (LPC)
Entity Type:Individual
Prefix:
First Name:DIXIE
Middle Name:RENEE
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:DIXIE
Other - Middle Name:
Other - Last Name:DRENNAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:203B WESTPORT DR
Mailing Address - Street 2:
Mailing Address - City:CABOT
Mailing Address - State:AR
Mailing Address - Zip Code:72023-3657
Mailing Address - Country:US
Mailing Address - Phone:501-843-9233
Mailing Address - Fax:501-843-9656
Practice Address - Street 1:203B WESTPORT DR
Practice Address - Street 2:
Practice Address - City:CABOT
Practice Address - State:AR
Practice Address - Zip Code:72023-3657
Practice Address - Country:US
Practice Address - Phone:501-843-9233
Practice Address - Fax:501-843-9656
Is Sole Proprietor?:No
Enumeration Date:2018-09-13
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP2007040101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR242686719Medicaid