Provider Demographics
NPI:1255825550
Name:DALTON, RANADA (LMHC, MAMFT)
Entity Type:Individual
Prefix:
First Name:RANADA
Middle Name:
Last Name:DALTON
Suffix:
Gender:F
Credentials:LMHC, MAMFT
Other - Prefix:
Other - First Name:RANADA
Other - Middle Name:
Other - Last Name:BOWIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1144 W 30TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46208-4929
Mailing Address - Country:US
Mailing Address - Phone:317-969-5694
Mailing Address - Fax:317-663-1000
Practice Address - Street 1:1144 W 30TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46208-4929
Practice Address - Country:US
Practice Address - Phone:317-969-5694
Practice Address - Fax:317-663-1000
Is Sole Proprietor?:No
Enumeration Date:2018-06-20
Last Update Date:2020-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39003303A101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
000001285099OtherANTHEM