Provider Demographics
NPI:1619687829
Name:SOGHOIAN, DIXIE (MHC-LP)
Entity Type:Individual
Prefix:
First Name:DIXIE
Middle Name:
Last Name:SOGHOIAN
Suffix:
Gender:F
Credentials:MHC-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 PACIFIC ST APT 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-2204
Mailing Address - Country:US
Mailing Address - Phone:917-842-1635
Mailing Address - Fax:
Practice Address - Street 1:26 COURT ST STE 403
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11242-1134
Practice Address - Country:US
Practice Address - Phone:917-842-1635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-29
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY111730-01101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty