Healthcare Provider Details

I. General information

NPI: 1154468379
Provider Name (Legal Business Name): PAMELA S ELLINGER-DIXON PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5001 HORIZONS DR STE 101
COLUMBUS OH
43220-5291
US

IV. Provider business mailing address

3287 NORTHAMPTON LN
HILLIARD OH
43026-2702
US

V. Phone/Fax

Practice location:
  • Phone: 614-451-2599
  • Fax: 614-771-7736
Mailing address:
  • Phone: 614-771-7736
  • Fax: 614-771-7736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number4468
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: