Healthcare Provider Details

I. General information

NPI: 1194647552
Provider Name (Legal Business Name): CHARISMA DIXON M.ED., QMHP, CSAC
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12711 DAYBREAK CIR
NEWPORT NEWS VA
23602-9504
US

IV. Provider business mailing address

12711 DAYBREAK CIR
NEWPORT NEWS VA
23602-9504
US

V. Phone/Fax

Practice location:
  • Phone: 804-475-8129
  • Fax:
Mailing address:
  • Phone: 804-475-8129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: