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NPI Code Detail

MEDICARE: DIXIE COLLINS LCDCIII

MEDICARE: DIXIE COLLINS LCDCIII
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
1101YA0400XAddiction (Substance Use Disorder) CounselorCDCA163656OH
2101YA0400XAddiction (Substance Use Disorder) CounselorLCDCII.161934OH
3104100000XSocial WorkerW.1900179OH
4101YA0400XAddiction (Substance Use Disorder) CounselorLCDCIII.162631

General Provider Information

NPI Number : 1720576390
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIXIE COLLINS LCDCIII
Provider Business Mailing Address
First Line : 110 HIGHLAND AVE
Second Line :
City : CIRCLEVILLE
State : OH
Zip : 43113-1208
Country : US
Telephone Number : 740-277-7512
Fax Number :
Provider Business Practice Location Address
First Line : 121 W MULBERRY ST
Second Line :
City : LANCASTER
State : OH
Zip : 43130-3014
Country : US
Telephone Number : 740-277-7512
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/28/2018
Last Update Date : 03/05/2025

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