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General NPI Number Information
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NPI Number | 1295203610
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Entity Type | Individual
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Provider Name | ANTWAN TAVARIOUS DIXON LPC
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Gender | Male
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Dates
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Enumeration Date | 11/02/2018
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Last Update Date | 11/16/2025
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Provider Practice Location Address
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Address Line | 2782 N COBB PKWY
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City | KENNESAW
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State | GA
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Zip | 30152-3472
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Country | US
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Telephone | 866-389-2727
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Fax |
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Provider Business Mailing Address
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Address Line | 2100 SOUTHBRIDGE PKWY STE 650
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City | BIRMINGHAM
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State | AL
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Zip | 35209-1317
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Country | US
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Telephone | 205-821-6273
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC012255
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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 | LPC03905
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License Number State | AL
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