MEDICARE: MR. JOSEPH WARREN 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	P008005	NC

General Provider Information

NPI Number	:	1841637410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSEPH WARREN DIXON

Provider Business Mailing Address
First Line	:	6646 E WT HARRIS BLVD STE C
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28215-5141
Country	:	US
Telephone Number	:	704-392-6003
Fax Number	:

Provider Business Practice Location Address
First Line	:	7629 RED MULBERRY WAY
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28273-9623
Country	:	US
Telephone Number	:	704-522-6250
Fax Number	:

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

Provider Enumeration Date	:	05/23/2013
Last Update Date	:	05/23/2013

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