Provider Demographics
NPI:1861145682
Name:DITO, MICHELLE NATALIE
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:NATALIE
Last Name:DITO
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 1:5550 PAINTED MIRAGE RD STE 380
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-4727
Mailing Address - Country:US
Mailing Address - Phone:480-217-9145
Mailing Address - Fax:
Practice Address - Street 1:5550 PAINTED MIRAGE RD STE 380
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-4727
Practice Address - Country:US
Practice Address - Phone:480-217-9145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-01
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11318-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical