Provider Demographics
NPI:1417313370
Name:DODSON, DANA GRAVES (MS)
Entity Type:Individual
Prefix:MRS
First Name:DANA
Middle Name:GRAVES
Last Name:DODSON
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 1:506 MACI CT
Mailing Address - Street 2:
Mailing Address - City:SILOAM SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72761-2563
Mailing Address - Country:US
Mailing Address - Phone:479-871-3502
Mailing Address - Fax:
Practice Address - Street 1:105 E ALPINE ST STE 23
Practice Address - Street 2:
Practice Address - City:SILOAM SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72761-3199
Practice Address - Country:US
Practice Address - Phone:479-871-3502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-07
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
OK101YM0800X
ARP2201006101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor