Provider Demographics
NPI:1487241279
Name:DIXON, DETRIA MICHELLE (LSW)
Entity type:Individual
Prefix:
First Name:DETRIA
Middle Name:MICHELLE
Last Name:DIXON
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 HAVERHILL ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15221-1411
Mailing Address - Country:US
Mailing Address - Phone:412-606-6716
Mailing Address - Fax:
Practice Address - Street 1:7227 HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15208-1814
Practice Address - Country:US
Practice Address - Phone:412-244-4700
Practice Address - Fax:412-244-4982
Is Sole Proprietor?:No
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW133831104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker