Dana S Dedolph, LPC
Individual provider Active NPI Counselor · Astoria, OR
NPI 1851671960 · NPPES record last updated Aug 19, 2011
Key facts
- NPI
- 1851671960
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counselor 101Y00000X
- License
- C1489 (OR)
- Practice address
- 100 39TH St # 2B
Astoria, OR 97103-2499 - Phone
- (503) 325-2398
- Fax
- (503) 325-5932
- NPI assigned
- Aug 19, 2011
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C1489 | OR | MD | Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | C1489 | OR | Yes |
Addresses
Primary practice location
100 39TH St # 2B
Astoria, OR 97103-2499
Mailing address
100 39TH St # 2B
Astoria, OR 97103-2499
Phone (503) 325-2398
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710172802 | Other | OR | AGENCY NPI |
Other providers in Astoria, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 19, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.