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NPI Code Detail

MEDICARE: DIXIE ALLISON LCSW

MEDICARE: DIXIE ALLISON 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
11041C0700XClinical Social WorkerSW15668FL

General Provider Information

NPI Number : 1952969107
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIXIE ALLISON LCSW
Provider Business Mailing Address
First Line : PO BOX 1845
Second Line :
City : LYNN HAVEN
State : FL
Zip : 32444-5845
Country : US
Telephone Number : 850-384-6591
Fax Number :
Provider Business Practice Location Address
First Line : 7108 QUAIL HOLLOW DR
Second Line :
City : PANAMA CITY BEACH
State : FL
Zip : 32408-4984
Country : US
Telephone Number : 850-400-2692
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/03/2019
Last Update Date : 06/21/2019

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