NPIMap

Organization Active NPI

Dixon Social Interactive Services, Inc.

  • Professional Counselor
  • Greenville, NC
National Provider Identifier
1841411071
Registry record updated Dec 15, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
200100499 Issued in NC
Legal business name
DIXON SOCIAL INTERACTIVE SERVICES, INC.
Practice address
313 Clifton St.
Greenville, NC 27858-8504
Phone
(252) 353-0100
Fax
(252) 364-8117
NPI assigned
May 2, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Derria Dixon
Title
Cfo
Phone
(252) 258-8946

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X 200100499 NC
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X 200100499 NC
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X 200100499 NC Primary

Addresses

Primary practice location

313 Clifton St.
Greenville, NC 27858-8504

Mailing address

PO Box 30166
Greenville, NC 27833-0166
Phone (252) 353-0100

Other identifiers 1

IdentifierTypeStateIssuer
6005438MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20141218001838 NC Part B Supplier - Clinic/Group Practice 3173846359 Receives reassigned benefits from 1 practitioner
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Goldsboro, NC; Greenville, NC; Kinston, NC; Wilson, NC

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Dixon Social Interactive Services Inc7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

313 Clifton St
Greenville, NC 27858
Phone (252) 439-1011

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178064000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1323907200000",
    "number": "1841411071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 30166",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "278330166",
            "telephone_number": "252-353-0100",
            "fax_number": "252-364-8117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "313 CLIFTON ST.",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "278588504",
            "telephone_number": "252-353-0100",
            "fax_number": "252-364-8117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIXON SOCIAL INTERACTIVE SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-02",
        "last_updated": "2011-12-15",
        "status": "A",
        "authorized_official_last_name": "DIXON",
        "authorized_official_first_name": "DERRIA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "252-258-8946",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "200100499",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "200100499",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "NC",
            "license": "200100499",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6005438",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.