Provider Demographics
NPI:1093356180
Name:BREEDLOVE, DANA SIEGEL (PHD)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:SIEGEL
Last Name:BREEDLOVE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 MILTON RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27712-1537
Mailing Address - Country:US
Mailing Address - Phone:919-699-6655
Mailing Address - Fax:
Practice Address - Street 1:960 CORPORATE DR STE 201
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NC
Practice Address - Zip Code:27278-8560
Practice Address - Country:US
Practice Address - Phone:919-568-3131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-01
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1936103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist