Provider Demographics
NPI:1649541285
Name:ANDRUS, DIXIE MARIE (MA)
Entity type:Individual
Prefix:MS
First Name:DIXIE
Middle Name:MARIE
Last Name:ANDRUS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 RALEIGH RD
Mailing Address - Street 2:
Mailing Address - City:SCHWENKSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19473-2803
Mailing Address - Country:US
Mailing Address - Phone:267-255-4234
Mailing Address - Fax:
Practice Address - Street 1:123 RALEIGH RD
Practice Address - Street 2:
Practice Address - City:SCHWENKSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19473-2803
Practice Address - Country:US
Practice Address - Phone:267-255-4234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-12
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst