Provider Demographics
NPI:1053966788
Name:GREGOIRE, DIXIE FAYE (SUDCC111-CS)
Entity type:Individual
Prefix:
First Name:DIXIE
Middle Name:FAYE
Last Name:GREGOIRE
Suffix:
Gender:F
Credentials:SUDCC111-CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 F ST STE 101
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93706-1608
Mailing Address - Country:US
Mailing Address - Phone:559-457-2302
Mailing Address - Fax:
Practice Address - Street 1:1410 F ST STE 101
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93706-1608
Practice Address - Country:US
Practice Address - Phone:559-457-2302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1095101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)