Provider Demographics
NPI:1770636359
Name:DIAZ-DIXON, ANNISA MARIA (LCPC)
Entity Type:Individual
Prefix:MS
First Name:ANNISA
Middle Name:MARIA
Last Name:DIAZ-DIXON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11716A PINE WAY
Mailing Address - Street 2:
Mailing Address - City:HUNTLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60142-7316
Mailing Address - Country:US
Mailing Address - Phone:630-400-6726
Mailing Address - Fax:
Practice Address - Street 1:47 CHURCH ST
Practice Address - Street 2:
Practice Address - City:LAKE ZURICH
Practice Address - State:IL
Practice Address - Zip Code:60047-1563
Practice Address - Country:US
Practice Address - Phone:847-367-5991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-005814101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional