Healthcare Provider Details

I. General information

NPI: 1679854384
Provider Name (Legal Business Name): TANISHA L. PERINE-DIXON LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2011
Last Update Date: 08/17/2020
Certification Date: 08/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E MCMILLAN ST
CINCINNATI OH
45206-1922
US

IV. Provider business mailing address

401 E MCMILLAN ST
CINCINNATI OH
45206-1922
US

V. Phone/Fax

Practice location:
  • Phone: 513-221-3350
  • Fax:
Mailing address:
  • Phone: 513-221-3350
  • Fax: 513-948-0087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number110327
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.1000454
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.2001829
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: