Provider Demographics
NPI:1629571112
Name:DEFONSO, DANA MARIE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:DANA
Middle Name:MARIE
Last Name:DEFONSO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 EASTGATE AVE
Mailing Address - Street 2:
Mailing Address - City:MONESSEN
Mailing Address - State:PA
Mailing Address - Zip Code:15062-1393
Mailing Address - Country:US
Mailing Address - Phone:724-684-6489
Mailing Address - Fax:724-684-7116
Practice Address - Street 1:2 EASTGATE AVE
Practice Address - Street 2:
Practice Address - City:MONESSEN
Practice Address - State:PA
Practice Address - Zip Code:15062-1393
Practice Address - Country:US
Practice Address - Phone:724-684-6489
Practice Address - Fax:724-684-7116
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-12
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC010331101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional