MEDICARE: BREONDA JAVONNE DIXON LCPC, LCADC

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	101Y00000X	Counselor	CP5702	NV

General Provider Information

NPI Number	:	1396177697
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BREONDA JAVONNE DIXON LCPC, LCADC

Provider Business Mailing Address
First Line	:	PO BOX 335122
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89033-5122
Country	:	US
Telephone Number	:	702-283-1437
Fax Number	:

Provider Business Practice Location Address
First Line	:	5510 S FORT APACHE RD STE 270
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-7700
Country	:	US
Telephone Number	:	702-283-1437
Fax Number	:

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

Provider Enumeration Date	:	08/08/2013
Last Update Date	:	11/04/2025

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