Provider Demographics
NPI:1225668262
Name:DUGGER, CELLI DAWN (LAC)
Entity Type:Individual
Prefix:MS
First Name:CELLI
Middle Name:DAWN
Last Name:DUGGER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1539 COUNTRYSIDE LN
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46231-3312
Mailing Address - Country:US
Mailing Address - Phone:317-730-2558
Mailing Address - Fax:
Practice Address - Street 1:3351 N MERIDIAN ST STE 110
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46208-4674
Practice Address - Country:US
Practice Address - Phone:317-730-2558
Practice Address - Fax:317-964-0452
Is Sole Proprietor?:No
Enumeration Date:2020-01-17
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN86000406A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN86000406AOtherINDIANA PROFESSIONAL LICENSING AGENCY