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General NPI Number Information
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NPI Number | 1841411071
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Entity Type | Organization
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Legal Business Name | DIXON SOCIAL INTERACTIVE SERVICES, INC.
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 12/15/2011
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Provider Practice Location Address
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Address Line | 313 CLIFTON ST.
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City | GREENVILLE
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State | NC
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Zip | 27858-8504
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Country | US
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Telephone | 252-353-0100
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Fax | 252-364-8117
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Provider Business Mailing Address
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Address Line | PO BOX 30166
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City | GREENVILLE
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State | NC
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Zip | 27833-0166
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Country | US
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Telephone | 252-353-0100
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Fax | 252-364-8117
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Authorized Official
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Title or Position | CFO
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Name | MRS. DERRIA DIXON
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Credential |
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Telephone | 252-258-8946
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 200100499
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 200100499
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 200100499
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License Number State | NC
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