Provider Demographics
NPI:1346671534
Name:WEAVER, DAGEN
Entity Type:Individual
Prefix:
First Name:DAGEN
Middle Name:
Last Name:WEAVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1059 VISTA PARK DRIVE SUITE B
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551
Mailing Address - Country:US
Mailing Address - Phone:617-326-3783
Mailing Address - Fax:
Practice Address - Street 1:588 NOWLINS MILL RD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:VA
Practice Address - Zip Code:24538-2152
Practice Address - Country:US
Practice Address - Phone:434-610-1081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-12
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor