Provider Demographics
NPI:1093382897
Name:DAHMER, JONNA R (LCSW)
Entity Type:Individual
Prefix:
First Name:JONNA
Middle Name:R
Last Name:DAHMER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3607 CORNSTALK RD
Mailing Address - Street 2:
Mailing Address - City:CRAWLEY
Mailing Address - State:WV
Mailing Address - Zip Code:24931-7253
Mailing Address - Country:US
Mailing Address - Phone:304-618-7334
Mailing Address - Fax:
Practice Address - Street 1:3607 CORNSTALK RD
Practice Address - Street 2:
Practice Address - City:CRAWLEY
Practice Address - State:WV
Practice Address - Zip Code:24931-7253
Practice Address - Country:US
Practice Address - Phone:304-618-7334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-09
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
WVCP009442881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVCP00944288OtherLICENSE NUMBER