Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | PY8356 | FL |
Y | 103G00000X | Clinical Psychologist | PY8356 | FL |
Y | 103TC0700X | Clinical Psychologist | PY8356 | FL |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PY8356 | FL |
N | 103TP2701X | Group Psychotherapist | PY8356 | FL |
NPI | 1598046286 |
---|---|
Provider Name | Dr. Patricia Shalene Dixon |
First Address | Palmetto, FL 34221-5044 |
Second Address | Palmetto, FL 34221-5044 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2011 |
Last Update Date | 24/10/2019 |