Provider Demographics
NPI:1144623059
Name:LEGGETT, DANA (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:DANA
Middle Name:
Last Name:LEGGETT
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 COMMERCIAL CENTER DR STE 2
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:AR
Mailing Address - Zip Code:72364-9616
Mailing Address - Country:US
Mailing Address - Phone:870-732-7920
Mailing Address - Fax:870-732-7923
Practice Address - Street 1:10862 NICHOLS BLVD APT 9-9
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-4240
Practice Address - Country:US
Practice Address - Phone:601-513-9562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-06
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
AR9083-M104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health