Provider Demographics
NPI:1144540493
Name:DIXON, VICKIE LA'NELL (CRC, LPC)
Entity type:Individual
Prefix:
First Name:VICKIE
Middle Name:LA'NELL
Last Name:DIXON
Suffix:
Gender:F
Credentials:CRC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3519 SHADOW RIDGE RD N
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27896-8660
Mailing Address - Country:US
Mailing Address - Phone:252-206-6163
Mailing Address - Fax:252-234-9967
Practice Address - Street 1:3519 SHADOW RIDGE RD N
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27896-8660
Practice Address - Country:US
Practice Address - Phone:252-206-6163
Practice Address - Fax:252-234-9967
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-09
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3609101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional