Professional Disclosure Statement

Name: Marti Milliken Dixon

Title: Supervising Professional Clinical Counselor

Business Address: 2300 Hubbard Rd., Madison, Ohio 44057

Business Phone: (440) 417-0006

Licensure: PCC-S #E0008441 Expiration: 5/18/17

Formal Professional Education:

University Degree Earned Dates Attended

Ohio Wesleyan University BA, Music Education 1989-1992

The University of Akron Child Development Associates 1996

John Carroll University MA, Community Counseling 2000-03

Areas of Competence:

Anxiety, Autism, Child Development, Clinical Diagnosis, Clinical Ethics and Boundaries, Clinical Evaluation, Clinical Supervision, Couples Counseling, Depression, Family Counseling, Gender Identity Issues, Grief, Obsessive Compulsive Disorder, Oppositional Defiant Disorder, and Suicidality

FEE SCHEDULE (Self-pay ONLY)

Intake (50-75 min.) $ 135

Family Session (50-75 min.) $ 125

Individual Session (50-75 min.) $ 120

This information is required by the counselor, social worker, and marriage & family therapist board, which regulates the practices of professional counseling, social work, and marriage & family therapy in this state. If you have complaints about professional services from a counselor, social worker, or marriage & family therapist contact the Ohio Counselor, Social Worker, and Marriage & Family Therapist Board:

50 West Broad Street, Suite 1075, Columbus, Ohio 43215-5919

(614) 466-0912

www.cswmft.ohio.gov