Healthcare Provider Details

I. General information

NPI: 1184588071
Provider Name (Legal Business Name): ASHLEY LACOLE DIXON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 FLOYD ST
BURLINGTON NC
27215-6809
US

IV. Provider business mailing address

703 FLOYD ST
BURLINGTON NC
27215-6809
US

V. Phone/Fax

Practice location:
  • Phone: 336-520-5514
  • Fax: 336-350-7163
Mailing address:
  • Phone: 336-520-5514
  • Fax: 336-350-7163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: