Provider Demographics
NPI:1699448704
Name:DIXON, DEMETRICE HUGHES (RSW)
Entity type:Individual
Prefix:MRS
First Name:DEMETRICE
Middle Name:HUGHES
Last Name:DIXON
Suffix:
Gender:F
Credentials:RSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1652 FOUNTAIN AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-6702
Mailing Address - Country:US
Mailing Address - Phone:504-401-6675
Mailing Address - Fax:
Practice Address - Street 1:11861 COURSEY BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-4404
Practice Address - Country:US
Practice Address - Phone:225-612-8656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-26
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11371101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health