Provider Demographics
NPI:1023573144
Name:SPOKANE, DANA (MA)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:SPOKANE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:
Other - Last Name:DOVITCH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:11684 VENTURA BLVD # 170
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-2699
Mailing Address - Country:US
Mailing Address - Phone:818-783-3262
Mailing Address - Fax:
Practice Address - Street 1:13749 RIVERSIDE DR STE 200A
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-2446
Practice Address - Country:US
Practice Address - Phone:818-783-3262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-02
Last Update Date:2019-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24875106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty