Healthcare Provider Details

I. General information

NPI: 1396393344
Provider Name (Legal Business Name): JAMIE L DIXON CDCA, MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2019
Last Update Date: 09/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 SAINT JOHNS RD STE D
LIMA OH
45804-4029
US

IV. Provider business mailing address

2727 SAINT JOHNS RD STE D
LIMA OH
45804-4029
US

V. Phone/Fax

Practice location:
  • Phone: 567-940-9145
  • Fax: 567-940-9803
Mailing address:
  • Phone: 567-940-9145
  • Fax: 567-940-9803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.167571
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: