Provider Demographics
NPI:1952965287
Name:DIXON, DESIREE M (MSW, LCSWA)
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:M
Last Name:DIXON
Suffix:
Gender:F
Credentials:MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:831 BAXTER ST STE 205
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28202-2719
Mailing Address - Country:US
Mailing Address - Phone:704-375-6310
Mailing Address - Fax:
Practice Address - Street 1:831 BAXTER ST STE 205
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28202-2719
Practice Address - Country:US
Practice Address - Phone:704-375-6310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-22
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0123921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical