Provider Demographics
NPI:1073647574
Name:KNIOLA, DWAYNE ALAN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:DWAYNE
Middle Name:ALAN
Last Name:KNIOLA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5252 N MERIDIAN ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46208-2652
Mailing Address - Country:US
Mailing Address - Phone:317-259-8202
Mailing Address - Fax:
Practice Address - Street 1:8465 KEYSTONE XING
Practice Address - Street 2:SUITE 145
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-4355
Practice Address - Country:US
Practice Address - Phone:317-257-1505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34005029A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical