Provider Demographics
NPI:1972779320
Name:DIXON-MCCULLUM, ADRIENNE MICHELE (PHD)
Entity type:Individual
Prefix:MS
First Name:ADRIENNE
Middle Name:MICHELE
Last Name:DIXON-MCCULLUM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:ADRIENNE
Other - Middle Name:MICHELE
Other - Last Name:DIXON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:2513 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16510-1511
Mailing Address - Country:US
Mailing Address - Phone:814-440-5179
Mailing Address - Fax:
Practice Address - Street 1:2513 HARRISON ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16510-1511
Practice Address - Country:US
Practice Address - Phone:814-440-5179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist