Provider Demographics
NPI:1417619925
Name:MAXWELL, DANA MARIE (BCBA)
Entity Type:Individual
Prefix:MS
First Name:DANA
Middle Name:MARIE
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4597 DONERAIL PL APT 3C
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-2357
Mailing Address - Country:US
Mailing Address - Phone:248-303-4179
Mailing Address - Fax:
Practice Address - Street 1:6102 ABBOT RD
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-1410
Practice Address - Country:US
Practice Address - Phone:517-940-4612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst