Organization
DIXON SOCIAL INTERACTIVE SERVICES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DERRIA DIXON (ADMINISTRATOR)
(252) 353-0100
Entity
Organization
Contact information
Practice address
1202-B VERNON AVENUE, KINSTON, NC 28501
(252) 353-0100
Mailing address
PO BOX 30166, GREENVILLE, NC 27833-0166
(252) 353-0100
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
MHL-025-018
NC
251S00000X
Community/Behavioral Health Agency
MHL-025-220
NC
251S00000X
Community/Behavioral Health Agency
MHL-054-145
NC
251S00000X
Community/Behavioral Health Agency
Primary
MHL-074-163
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5912833
—
NC
05
—
6005438
—
NC
05
—
8300651
—
NC
05
—
8300652
—
NC
05
—
8300653
—
NC
05
—
8302839
—
NC
Enumeration date
12/03/2010
Last updated
12/03/2010
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