Provider Demographics
NPI:1548963929
Name:DIXON, DAVID ROGER (MS, NCC, RMHCI)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ROGER
Last Name:DIXON
Suffix:
Gender:M
Credentials:MS, NCC, RMHCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18608 ROCOCO RD
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34610-0090
Mailing Address - Country:US
Mailing Address - Phone:813-541-9159
Mailing Address - Fax:
Practice Address - Street 1:3937 TAMPA RD STE 3
Practice Address - Street 2:
Practice Address - City:OLDSMAR
Practice Address - State:FL
Practice Address - Zip Code:34677-3115
Practice Address - Country:US
Practice Address - Phone:813-501-6129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-23
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH22242101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health