Provider Demographics
NPI:1326139429
Name:DAGG, DAVID (PCC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:DAGG
Suffix:
Gender:M
Credentials:PCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4773 CARROLL CEMETERY RD
Mailing Address - Street 2:
Mailing Address - City:CARROLL
Mailing Address - State:OH
Mailing Address - Zip Code:43112-9428
Mailing Address - Country:US
Mailing Address - Phone:614-568-3244
Mailing Address - Fax:740-422-1548
Practice Address - Street 1:4773 CARROLL CEMETERY RD
Practice Address - Street 2:
Practice Address - City:CARROLL
Practice Address - State:OH
Practice Address - Zip Code:43112-9428
Practice Address - Country:US
Practice Address - Phone:614-568-3244
Practice Address - Fax:740-422-1548
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE3699101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional