MEDICARE: SHEINA SADE DIXON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1063984391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHEINA SADE DIXON

Provider Business Mailing Address
First Line	:	6657 S BLACKSTONE AVE APT 3
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60637-4461
Country	:	US
Telephone Number	:	312-823-3962
Fax Number	:

Provider Business Practice Location Address
First Line	:	2600 S MICHIGAN AVE STE 211
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-2859
Country	:	US
Telephone Number	:	312-374-1917
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/27/2018
Last Update Date	:	12/27/2018

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