MEDICARE: DANIELLE NICOLE DIXON

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	APC008574	GA

General Provider Information

NPI Number	:	1760191050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE NICOLE DIXON

Provider Business Mailing Address
First Line	:	PO BOX 13289
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27709-3289
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	41 PERIMETER CTR E STE 640
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30346-1903
Country	:	US
Telephone Number	:	770-871-3730
Fax Number	:

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

Provider Enumeration Date	:	11/16/2022
Last Update Date	:	11/16/2022

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