Provider Demographics
NPI:1194158063
Name:DIXON, DUSTIN JAMES (MED)
Entity type:Individual
Prefix:MR
First Name:DUSTIN
Middle Name:JAMES
Last Name:DIXON
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3130 O ST SE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-8127
Mailing Address - Country:US
Mailing Address - Phone:208-420-6489
Mailing Address - Fax:
Practice Address - Street 1:3130 O ST SE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-8127
Practice Address - Country:US
Practice Address - Phone:208-420-6489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60398738101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health