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General NPI Number Information
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NPI Number | 1417431149
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Entity Type | Individual
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Provider Name | JONATHAN DIXON LMFT
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Gender | Male
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Dates
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Enumeration Date | 09/19/2018
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Last Update Date | 09/19/2018
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Provider Practice Location Address
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Address Line | 9677 MAIN ST # A-B
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City | FAIRFAX
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State | VA
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Zip | 22031-3763
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Country | US
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Telephone | 301-767-1733
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Fax |
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Provider Business Mailing Address
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Address Line | 318 N STRATTON ST
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City | GETTYSBURG
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State | PA
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Zip | 17325-1330
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Country | US
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Telephone |
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 0717001494
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License Number State | VA
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