Provider Demographics
NPI:1629008230
Name:DANA, GREGORY A (MA)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:A
Last Name:DANA
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3891 DREXEL AVE
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-2851
Mailing Address - Country:US
Mailing Address - Phone:847-623-6396
Mailing Address - Fax:
Practice Address - Street 1:690 OAK ST
Practice Address - Street 2:
Practice Address - City:WINNETKA
Practice Address - State:IL
Practice Address - Zip Code:60093-2522
Practice Address - Country:US
Practice Address - Phone:847-446-6955
Practice Address - Fax:847-446-6957
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-001461101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional