Healthcare Provider Details

I. General information

NPI: 1063984391
Provider Name (Legal Business Name): SHEINA SADE DIXON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2018
Last Update Date: 12/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 S MICHIGAN AVE STE 211
CHICAGO IL
60616-2859
US

IV. Provider business mailing address

6657 S BLACKSTONE AVE APT 3
CHICAGO IL
60637-4461
US

V. Phone/Fax

Practice location:
  • Phone: 312-374-1917
  • Fax:
Mailing address:
  • Phone: 312-823-3962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: