Provider Demographics
NPI:1407513245
Name:CZERNIAK, DAKOTA RAY (MS)
Entity Type:Individual
Prefix:MRS
First Name:DAKOTA
Middle Name:RAY
Last Name:CZERNIAK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12603 ASHMORE GREEN DR N
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-7239
Mailing Address - Country:US
Mailing Address - Phone:407-467-0833
Mailing Address - Fax:
Practice Address - Street 1:804 3RD ST
Practice Address - Street 2:
Practice Address - City:NEPTUNE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32266-5040
Practice Address - Country:US
Practice Address - Phone:904-801-9563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-29
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH18056101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty