Healthcare Provider Details

I. General information

NPI: 1265998959
Provider Name (Legal Business Name): CAITLIN DIXON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2019
Last Update Date: 10/19/2020
Certification Date: 10/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 BYRD AVE
RICHMOND VA
23230-3033
US

IV. Provider business mailing address

1900 BYRD AVE
RICHMOND VA
23230-3033
US

V. Phone/Fax

Practice location:
  • Phone: 804-592-6311
  • Fax: 844-227-7690
Mailing address:
  • Phone: 804-592-6311
  • Fax: 844-227-7690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701009202
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: