Provider Demographics
NPI:1962701706
Name:DIXON-WOODLEY, ASHA SIMONE (LMSW)
Entity type:Individual
Prefix:MRS
First Name:ASHA
Middle Name:SIMONE
Last Name:DIXON-WOODLEY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MRS
Other - First Name:ASHA
Other - Middle Name:SIMONE
Other - Last Name:DIXON-WOODLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:3957 WINDY HTS
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-3591
Mailing Address - Country:US
Mailing Address - Phone:217-848-0553
Mailing Address - Fax:
Practice Address - Street 1:2580 EATON RAPIDS RD
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-6307
Practice Address - Country:US
Practice Address - Phone:217-848-0553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-18
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA006851104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker