| Raphilla D Dixie, | |
|
3005 E State Blvd, Fort Wayne, IN 46805-4736 | |
| (260) 267-9498 | |
| (260) 739-3618 |
| Full Name | Raphilla D Dixie |
|---|---|
| Gender | Female |
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 3005 E State Blvd, Fort Wayne, Indiana |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003465873 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 87001756A (Indiana) | Primary |
| Entity Name | Cleanslate Medical Group Of Indiana Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1023464294 PECOS PAC ID: 4880963909 Enrollment ID: O20171023001515 |
| Mailing Address | Practice Location Address |
|---|---|
| Raphilla D Dixie, 3005 E State Blvd, Fort Wayne, IN 46805-4736 Ph: (260) 267-9498 | Raphilla D Dixie, 3005 E State Blvd, Fort Wayne, IN 46805-4736 Ph: (260) 267-9498 |
Courtney Lesley Washington, Counselor Medicare: Accepting Medicare Assignments Practice Location: 909 E State Blvd, Fort Wayne, IN 46805 Phone: 260-481-2700 | |
Alicia Jean Digiulio, MA, MSED, LMHC Counselor Medicare: Not Enrolled in Medicare Practice Location: 9417 Saint Joe Center Rd, Fort Wayne, IN 46835 Phone: 260-255-5289 | |
Jennifer Perry, MS Counselor Medicare: Not Enrolled in Medicare Practice Location: 909 E State Blvd, Fort Wayne, IN 46805 Phone: 260-481-2700 Fax: 260-481-2709 | |
Timothy Jay Hill, MSED Counselor Medicare: Not Enrolled in Medicare Practice Location: 2100 Goshen Rd, Fort Wayne, IN 46808 Phone: 260-471-3500 | |
Mrs. Molly Christina Colglazier, Counselor Medicare: Not Enrolled in Medicare Practice Location: 10102 Woodland Plaza Cv Ste A, Fort Wayne, IN 46825 Phone: 260-240-4200 | |
Rita Kay Self, M.S. Counselor Medicare: Not Enrolled in Medicare Practice Location: 3010 E State Blvd, Fort Wayne, IN 46805 Phone: 260-471-2300 Fax: 260-471-2778 |