=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659588341
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALEXANDER DIXIE V
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/16/2007
-----------------------------------------------------
Last Update Date | 02/21/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 325 NORTH 1ST
-----------------------------------------------------
City | ARKANSAS CITY
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67005-1012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 620-442-1313
-----------------------------------------------------
Fax | 620-442-1313
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1012
-----------------------------------------------------
City | ARKANSAS CITY
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67005-1012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 620-442-1313
-----------------------------------------------------
Fax | 620-442-2808
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOLE PROPRIETOR
-----------------------------------------------------
Name | MS. DIXIE V ALEXANDER
-----------------------------------------------------
Credential | LSCSW AAPS SAP
-----------------------------------------------------
Telephone | 620-442-1313
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | LSCSW1012
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------