Provider Demographics
NPI:1336449693
Name:DIXON, CARRIE B (PHD)
Entity type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:B
Last Name:DIXON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 W 11TH ST
Mailing Address - Street 2:200
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46016-2069
Mailing Address - Country:US
Mailing Address - Phone:317-643-0181
Mailing Address - Fax:317-643-3442
Practice Address - Street 1:100 W 11TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46016-2069
Practice Address - Country:US
Practice Address - Phone:765-643-0181
Practice Address - Fax:765-643-0181
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20040075A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100323740AMedicaid