Healthcare Provider Details

I. General information

NPI: 1639624646
Provider Name (Legal Business Name): JAMES DIXON M.ED., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2016
Last Update Date: 06/15/2020
Certification Date: 06/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17255 SANTA FE ST
HAYWARD CA
94541-1055
US

IV. Provider business mailing address

17255 SANTA FE ST
HAYWARD CA
94541-1055
US

V. Phone/Fax

Practice location:
  • Phone: 415-632-9976
  • Fax:
Mailing address:
  • Phone: 415-632-9976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberR1333270119
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: