Healthcare Provider Details

I. General information

NPI: 1609719301
Provider Name (Legal Business Name): KIMBERLY DIXON RESIDENT IN COUNSELI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2026
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 NAT TURNER BLVD S
NEWPORT NEWS VA
23606-2898
US

IV. Provider business mailing address

105 NAT TURNER BLVD S
NEWPORT NEWS VA
23606-2898
US

V. Phone/Fax

Practice location:
  • Phone: 757-599-0800
  • Fax:
Mailing address:
  • Phone: 757-599-0800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0704009132
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: