Provider Demographics
NPI:1477335743
Name:DIX, AMBER
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:DIX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 E EXCHANGE ST APT 221-A
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44308-1535
Mailing Address - Country:US
Mailing Address - Phone:678-668-1469
Mailing Address - Fax:
Practice Address - Street 1:80 E EXCHANGE ST APT 221-A
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44308-1535
Practice Address - Country:US
Practice Address - Phone:678-668-1469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-19
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities