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NPI Code Detail

MEDICARE: CANDICE ROBINSON DIXON BCBA

MEDICARE: CANDICE ROBINSON DIXON BCBA
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
1103K00000XBehavior Analyst12147847

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
112147847OTHERGABCBA

General Provider Information

NPI Number : 1457838211
Entity Type Code : Individual
Provider Name (Legal Business Name) : CANDICE ROBINSON DIXON BCBA
Provider Business Mailing Address
First Line : 125 MINGLEDORFF WAY
Second Line :
City : SPRINGFIELD
State : GA
Zip : 31329-5085
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 806 TOWNE PARK DR
Second Line :
City : RINCON
State : GA
Zip : 31326-9368
Country : US
Telephone Number : 912-312-4588
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/24/2018
Last Update Date : 06/11/2025

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