Provider Demographics
NPI:1700384245
Name:DIX, ASIA ANNA
Entity Type:Individual
Prefix:
First Name:ASIA
Middle Name:ANNA
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 1:3145 N MICHAEL WAY APT A
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-4194
Mailing Address - Country:US
Mailing Address - Phone:775-479-9468
Mailing Address - Fax:
Practice Address - Street 1:3145 N MICHAEL WAY APT A
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89108-4194
Practice Address - Country:US
Practice Address - Phone:775-479-9468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-30
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1215305818Medicaid
NV$$$$$$$$$Medicaid