Provider Demographics
NPI:1083153100
Name:DAGRIN, ANN
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:DAGRIN
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 1:1451 HIGHWAY 190 E
Mailing Address - Street 2:APT 5
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70401-9586
Mailing Address - Country:US
Mailing Address - Phone:401-269-9145
Mailing Address - Fax:
Practice Address - Street 1:406 W MORRIS AVE
Practice Address - Street 2:SUITE B
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-4150
Practice Address - Country:US
Practice Address - Phone:985-402-3698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-22
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health