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General NPI Number Information
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NPI Number | 1124398789
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Entity Type | Individual
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Provider Name | KENYON KENYATTA DIXON LPC
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Gender | Female
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Dates
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Enumeration Date | 01/12/2012
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Last Update Date | 02/10/2025
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Provider Practice Location Address
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Address Line | 6055 LAKESIDE COMMONS DR STE 320
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City | MACON
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State | GA
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Zip | 31210-5791
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Country | US
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Telephone | 478-238-9344
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Fax |
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Provider Business Mailing Address
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Address Line | 415 N JACKSON ST
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City | AMERICUS
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State | GA
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Zip | 31709-3015
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Country | US
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Telephone | 229-931-2470
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Fax | 229-931-2474
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | APC002359
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC006899
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License Number State | GA
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