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General NPI Number Information
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NPI Number | 1760192280
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Entity Type | Organization
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Legal Business Name | ANTWAN TAVARIOUS DIXON LLC
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Dates
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Enumeration Date | 11/28/2022
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Last Update Date | 11/28/2022
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Provider Practice Location 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 | 800-916-3713
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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 |
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Fax |
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Authorized Official
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Title or Position | OWNER/LICENSED PROF. COUNSELOR
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Name | MR. ANTWAN TAVARIOUS DIXON
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Credential | EDS, LPC, NCC
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Telephone | 800-916-3713
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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 |
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License Number State |
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