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Individual
THADDEUS DIXON
Active
Individual
THADDEUS DIXON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CACP
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
SC
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
AD01AK
—
SC
Enumeration date
01/08/2015
Last updated
01/08/2015
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