Provider Demographics
NPI:1386334118
Name:DOGAN-DIXON, JARDIN (PHD)
Entity type:Individual
Prefix:
First Name:JARDIN
Middle Name:
Last Name:DOGAN-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 1:959 LAKE HARBOUR DR APT 1401
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-1079
Mailing Address - Country:US
Mailing Address - Phone:803-493-2573
Mailing Address - Fax:
Practice Address - Street 1:959 LAKE HARBOUR DR APT 1401
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-1079
Practice Address - Country:US
Practice Address - Phone:803-493-2573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS631155103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling