Provider Demographics
NPI:1932712890
Name:DIXON, SOPHIA (LPC)
Entity Type:Individual
Prefix:
First Name:SOPHIA
Middle Name:
Last Name:DIXON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 N MATTIS AVE STE 116
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61821-7900
Mailing Address - Country:US
Mailing Address - Phone:217-203-2008
Mailing Address - Fax:844-412-7089
Practice Address - Street 1:313 N MATTIS AVE STE 116
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61821-7900
Practice Address - Country:US
Practice Address - Phone:217-203-2008
Practice Address - Fax:844-412-7089
Is Sole Proprietor?:No
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178016223101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional