Provider Demographics
NPI:1225408040
Name:LADONNA DAHL PSY.D., INC.
Entity Type:Organization
Organization Name:LADONNA DAHL PSY.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LADONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAHL
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:786-512-9983
Mailing Address - Street 1:4110 SOUTHPOINT BLVD
Mailing Address - Street 2:STE 114
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-0947
Mailing Address - Country:US
Mailing Address - Phone:786-512-9983
Mailing Address - Fax:888-557-6165
Practice Address - Street 1:4110 SOUTHPOINT BLVD
Practice Address - Street 2:STE 114
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-0947
Practice Address - Country:US
Practice Address - Phone:786-512-9983
Practice Address - Fax:888-557-6165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-06
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8020103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty