Healthcare Provider Details

I. General information

NPI: 1912820069
Provider Name (Legal Business Name): BROOKLYNN C DIXON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 LENA DR
ROGERSVILLE TN
37857-2951
US

IV. Provider business mailing address

1167 SPRATLIN PARK DR
GRAY TN
37615-6205
US

V. Phone/Fax

Practice location:
  • Phone: 423-272-9239
  • Fax: 423-272-1803
Mailing address:
  • Phone: 423-467-3600
  • Fax: 423-467-3644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10498
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: