Basic Information
| Provider Information | |||||||||
| NPI: | 1003015876 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ANDERSON | ||||||||
| FirstName: | DANA | ||||||||
| MiddleName: | KAY | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MA, LLPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 901 EASTERN AVE NE | ||||||||
| Address2: | |||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495031201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6162547741 | ||||||||
| FaxNumber: | 6162547750 | ||||||||
| Practice Location | |||||||||
| Address1: | 901 EASTERN AVE NE | ||||||||
| Address2: | |||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495031201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6162547741 | ||||||||
| FaxNumber: | 6162547750 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2007 | ||||||||
| LastUpdateDate: | 07/12/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 6401009024 | MI | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.