Individual
CHEVELL DIXON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
168 LONESOME PINE RD, LONGVIEW, TX 75605-7300
(903) 746-9033
Mailing address
168 LONESOME PINE RD, LONGVIEW, TX 75605-7300
(903) 746-9033
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
—
TX
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
TX
Other
Enumeration date
05/19/2018
Last updated
07/26/2024
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