Provider Demographics
NPI:1841616810
Name:DIXON, TARA (LCSW)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:DIXON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 S SEMORAN BLVD STE 1150
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-5505
Mailing Address - Country:US
Mailing Address - Phone:321-746-3889
Mailing Address - Fax:386-753-9265
Practice Address - Street 1:1035 S SEMORAN BLVD
Practice Address - Street 2:SUITE 1047
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-5526
Practice Address - Country:US
Practice Address - Phone:321-746-3889
Practice Address - Fax:386-753-9265
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-13
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YM0800X, 104100000X, 106H00000X
FLSW188421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist