MEDICARE: DIXIE DIANE DAKOS

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	:	1184138323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIXIE DIANE DAKOS

Provider Business Mailing Address
First Line	:	2694 BRUCE ST
Second Line	:
City	:	MATLACHA
State	:	FL
Zip	:	33993-9791
Country	:	US
Telephone Number	:	239-218-2269
Fax Number	:

Provider Business Practice Location Address
First Line	:	2694 BRUCE ST
Second Line	:
City	:	MATLACHA
State	:	FL
Zip	:	33993-9791
Country	:	US
Telephone Number	:	239-218-2269
Fax Number	:

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

Provider Enumeration Date	:	11/27/2017
Last Update Date	:	11/27/2017

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Directions to “ DIXIE DIANE DAKOS ” Practice Location

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