Provider Demographics
NPI:1144967076
Name:DIXON, ANDREA (LAC)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:DIXON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745 OLD WARREN RD
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:AR
Mailing Address - Zip Code:71655-9713
Mailing Address - Country:US
Mailing Address - Phone:870-367-9035
Mailing Address - Fax:870-367-9038
Practice Address - Street 1:745 OLD WARREN RD
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:AR
Practice Address - Zip Code:71655-9713
Practice Address - Country:US
Practice Address - Phone:870-367-9035
Practice Address - Fax:870-367-9038
Is Sole Proprietor?:No
Enumeration Date:2022-05-12
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
ARA2307029101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator