Healthcare Provider Details

I. General information

NPI: 1174939821
Provider Name (Legal Business Name): DIXON COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2014
Last Update Date: 07/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

685 MAIN ST SUITE C
SAFETY HARBOR FL
34695-3562
US

IV. Provider business mailing address

685 MAIN ST SUITE C
SAFETY HARBOR FL
34695-3562
US

V. Phone/Fax

Practice location:
  • Phone: 727-565-3818
  • Fax: 727-800-2333
Mailing address:
  • Phone: 727-565-3818
  • Fax: 727-800-2333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH11493
License Number StateFL

VIII. Authorized Official

Name: YVETTE M DIXON
Title or Position: SOLE MEMBER
Credential: LMHC
Phone: 727-565-3818