Provider Demographics
NPI:1912458894
Name:GILLIAN A. DIXON, LMSW, PLLC
Entity Type:Organization
Organization Name:GILLIAN A. DIXON, LMSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:GILLIAN
Authorized Official - Middle Name:ALISON
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:248-838-8339
Mailing Address - Street 1:1193 ELLIOTT AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-2674
Mailing Address - Country:US
Mailing Address - Phone:248-838-8339
Mailing Address - Fax:
Practice Address - Street 1:999 HAYNES ST
Practice Address - Street 2:SUITE 235
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-6712
Practice Address - Country:US
Practice Address - Phone:248-838-8339
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-17
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801081849251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health