Provider Demographics
NPI:1841910957
Name:DIXON, SALLY KATELYN (LCMHC-A)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:KATELYN
Last Name:DIXON
Suffix:
Gender:F
Credentials:LCMHC-A
Other - Prefix:
Other - First Name:SALLY
Other - Middle Name:DIXON
Other - Last Name:RIVENBARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5000 FALLS OF NEUSE RD STE 300
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-5480
Mailing Address - Country:US
Mailing Address - Phone:919-865-8710
Mailing Address - Fax:919-256-0772
Practice Address - Street 1:5000 FALLS OF NEUSE RD STE 300
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-5480
Practice Address - Country:US
Practice Address - Phone:919-865-8710
Practice Address - Fax:919-256-0772
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-30
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17873101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health