Healthcare Provider Details

I. General information

NPI: 1114502432
Provider Name (Legal Business Name): WHITNEY DIXON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2021
Last Update Date: 03/24/2023
Certification Date: 03/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 E RIVER PL
JACKSON MS
39202-3442
US

IV. Provider business mailing address

228 HAWTHORNE DR
MADISON MS
39110-9334
US

V. Phone/Fax

Practice location:
  • Phone: 769-251-5550
  • Fax:
Mailing address:
  • Phone: 601-942-1477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateMS
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: