Provider Demographics
NPI:1629258512
Name:DASH, VIDA R (MA, LPC, NCC)
Entity Type:Individual
Prefix:MS
First Name:VIDA
Middle Name:R
Last Name:DASH
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 461384
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78246-1384
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20770 US HIGHWAY 281 N
Practice Address - Street 2:108
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-7519
Practice Address - Country:US
Practice Address - Phone:888-333-3069
Practice Address - Fax:888-897-0802
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-07
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69746101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional