Healthcare Provider Details

I. General information

NPI: 1689395345
Provider Name (Legal Business Name): HAYLEY DREW DIXON PSY.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2022
Last Update Date: 10/17/2023
Certification Date: 10/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 JUFFAIR AVENUE BANZ WAREHOUSE, BAY 6
MANAMA BAHRAIN
09834
BH

IV. Provider business mailing address

PSC 851 BOX 340
FPO AE
09834-0004
US

V. Phone/Fax

Practice location:
  • Phone: 318-439-6110
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810008316
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: