Provider Demographics
NPI:1932735024
Name:DIXON, DOUGLAS ANTHONY (LMHC-A)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:ANTHONY
Last Name:DIXON
Suffix:
Gender:M
Credentials:LMHC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 JOHNSON LN
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47129-1405
Mailing Address - Country:US
Mailing Address - Phone:126-706-7338
Mailing Address - Fax:
Practice Address - Street 1:1611 JOHNSON LN
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47129-1405
Practice Address - Country:US
Practice Address - Phone:812-670-6733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-20
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN8800099A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health