Healthcare Provider Details

I. General information

NPI: 1679653588
Provider Name (Legal Business Name): BRENDA M. DIXON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 PURDUE DR STE 200
FAYETTEVILLE NC
28303-5510
US

IV. Provider business mailing address

1442 GLANIS DR
FAYETTEVILLE NC
28304-0319
US

V. Phone/Fax

Practice location:
  • Phone: 910-867-8889
  • Fax: 910-487-3061
Mailing address:
  • Phone: 910-384-2798
  • Fax: 910-487-3061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number5295
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: