Healthcare Provider Details

I. General information

NPI: 1952405532
Provider Name (Legal Business Name): JAMIE EDWARDS DIXON LICSW, LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 04/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 RHODE ISLAND AVE NW
WASHINGTON DC
20001-4153
US

IV. Provider business mailing address

13110 FALLING WATER CT
BOWIE MD
20720-3270
US

V. Phone/Fax

Practice location:
  • Phone: 202-403-2801
  • Fax: 202-483-4560
Mailing address:
  • Phone: 202-491-3298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14602
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC303476
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: