Provider Demographics
NPI:1992885008
Name:DIXON, RALPH THOMAS JR (LCSW)
Entity type:Individual
Prefix:MR
First Name:RALPH
Middle Name:THOMAS
Last Name:DIXON
Suffix:JR
Gender:M
Credentials:LCSW
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Mailing Address - Street 1:35 COLLIER RD NW
Mailing Address - Street 2:SUITE M-215
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1613
Mailing Address - Country:US
Mailing Address - Phone:404-355-2914
Mailing Address - Fax:404-355-2917
Practice Address - Street 1:35 COLLIER RD NW
Practice Address - Street 2:SUITE M-215
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1613
Practice Address - Country:US
Practice Address - Phone:404-355-2914
Practice Address - Fax:404-355-2917
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2012-11-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GACSW0006061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACSW000606OtherCLINICAL SOCIAL WORKER