Individual
RAPHILLA D DIXIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3005 E STATE BLVD, FORT WAYNE, IN 46805-4736
(260) 267-9498
(260) 739-3618
Mailing address
3005 E STATE BLVD, FORT WAYNE, IN 46805-4736
(260) 267-9498
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
87001756A
IN
Other
Enumeration date
09/05/2019
Last updated
04/03/2024
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