Provider Demographics
NPI:1609914977
Name:HORNE, DANA EDWARDS (LCSW)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:EDWARDS
Last Name:HORNE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2158
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-2158
Mailing Address - Country:US
Mailing Address - Phone:704-892-2254
Mailing Address - Fax:704-892-0366
Practice Address - Street 1:21300 CATAWBA AVE
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-8505
Practice Address - Country:US
Practice Address - Phone:704-892-2254
Practice Address - Fax:704-892-0366
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0039011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6002306Medicaid