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NPI Code Detail

MEDICARE: TRINA DIXON MHC

MEDICARE: TRINA DIXON MHC
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1730724915
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRINA DIXON MHC
Provider Business Mailing Address
First Line : 741 DELAWARE AVE
Second Line :
City : BUFFALO
State : NY
Zip : 14209-2201
Country : US
Telephone Number : 716-218-1400
Fax Number :
Provider Business Practice Location Address
First Line : 1465 PAYNE AVE
Second Line :
City : NORTH TONAWANDA
State : NY
Zip : 14120-2511
Country : US
Telephone Number : 716-694-7749
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/12/2019
Last Update Date : 11/12/2019

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