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General NPI Number Information
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NPI Number | 1740640507
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Entity Type | Individual
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Provider Name | BRADLEY DIXON MSW / ACSW
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Gender | Male
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Dates
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Enumeration Date | 03/07/2016
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Last Update Date | 03/07/2016
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Provider Practice Location Address
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Address Line | 901 CHIPPEWA ST
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City | FLINT
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State | MI
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Zip | 48503-1552
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Country | US
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Telephone | 810-232-9950
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Fax | 810-232-3869
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Provider Business Mailing Address
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Address Line | 1522 HUGHES AVE
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City | FLINT
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State | MI
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Zip | 48503-3270
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Country | US
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Telephone | 810-252-4163
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801035592
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License Number State | MI
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