Provider Demographics
NPI:1548008840
Name:MANOS, ASHLEE DIXON (LAC)
Entity type:Individual
Prefix:
First Name:ASHLEE
Middle Name:DIXON
Last Name:MANOS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:ASHLEE
Other - Middle Name:SUZANNE
Other - Last Name:DIXON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:78 SYCAMORE AVE UNIT 30187
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29417-2709
Mailing Address - Country:US
Mailing Address - Phone:229-425-8679
Mailing Address - Fax:
Practice Address - Street 1:720 MAGNOLIA RD STE 11
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-7094
Practice Address - Country:US
Practice Address - Phone:229-425-8679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-19
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC258171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist