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General NPI Number Information
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NPI Number | 1205998010
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Entity Type | Individual
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Provider Name | DIXIE L GEORGE MSW
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Gender | Female
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Dates
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Enumeration Date | 12/15/2006
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Last Update Date | 10/18/2012
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Provider Practice Location Address
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Address Line | 30 MERLOT DRIVE SUITE F
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City | PROSSER
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State | WA
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Zip | 99350
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Country | US
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Telephone | 509-303-9947
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1539
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City | PROSSER
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State | WA
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Zip | 99350-0833
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Country | US
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Telephone | 509-303-9947
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Fax |
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CP 60010572
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LW60140442
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License Number State | WA
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