Provider Demographics
NPI:1699535443
Name:DIXON, DAYNA MARIE
Entity type:Individual
Prefix:
First Name:DAYNA
Middle Name:MARIE
Last Name:DIXON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12626 BLANCO RD APT 1704
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-8197
Mailing Address - Country:US
Mailing Address - Phone:512-971-6268
Mailing Address - Fax:
Practice Address - Street 1:12626 BLANCO RD APT 1704
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-8197
Practice Address - Country:US
Practice Address - Phone:512-971-6268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX92137101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional