MEDICARE: CECELIA DIXIE M.S.W. - LCSW

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	1041C0700X	Clinical Social Worker	CSW005169	GA

General Provider Information

NPI Number	:	1851624993
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CECELIA DIXIE M.S.W. - LCSW

Provider Business Mailing Address
First Line	:	3300 STADIUM DR
Second Line	:	APT. 210
City	:	PHENIX CITY
State	:	AL
Zip	:	36867-3184
Country	:	US
Telephone Number	:	706-566-4602
Fax Number	:

Provider Business Practice Location Address
First Line	:	1700 CLAIRMONT RD
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30033-4032
Country	:	US
Telephone Number	:	404-321-6111
Fax Number	:	404-929-5819

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

Provider Enumeration Date	:	09/08/2009
Last Update Date	:	04/04/2016

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