Healthcare Provider Details

I. General information

NPI: 1679163497
Provider Name (Legal Business Name): EBONEE JANAE DIXON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2021
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 W PRATT ST FL 4
BALTIMORE MD
21201-1023
US

IV. Provider business mailing address

701 W PRATT ST FL 4
BALTIMORE MD
21201-1023
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-2539
  • Fax: 410-328-8552
Mailing address:
  • Phone: 410-328-2539
  • Fax: 410-328-8552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number25924
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: