Provider Demographics
NPI:1841637410
Name:DIXON, JOSEPH WARREN
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:WARREN
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 1:6646 E WT HARRIS BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-5141
Mailing Address - Country:US
Mailing Address - Phone:704-392-6003
Mailing Address - Fax:
Practice Address - Street 1:7629 RED MULBERRY WAY
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-9623
Practice Address - Country:US
Practice Address - Phone:704-522-6250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-23
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP008005101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health