Most Relevant Information
Provider Data
| NPI Number: | 1003465873 |
| Provider Name: | RAPHILLA D DIXIE |
| Entity Type: | Individual |
| Taxonomy Code: | 101YA0400X |
| Specialty: | Counselor |
| License Number: | 87001756A |
Most Important Dates
| Enumeration Date: | 09/05/2019 |
| Last Updated: | 04/03/2024 |
Provider Practice Location
3005 E STATE BLVD
FORT WAYNE
IN
468054736
Practice Location Phone/Fax
| Phone: | 2602679498 |
| Fax: | 2607393618 |
Provider Mailing Location
3005 E STATE BLVD
FORT WAYNE
IN
468054736
Provider Mailing Phone/Fax
| Phone: | 2602679498 |
| Fax: |