Provider Demographics
NPI:1639647878
Name:KING, DANA (LCPC)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7737 N EASTLAKE TER APT 3M
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-1333
Mailing Address - Country:US
Mailing Address - Phone:312-636-9571
Mailing Address - Fax:
Practice Address - Street 1:1830 SHERMAN AVE STE 404
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-3774
Practice Address - Country:US
Practice Address - Phone:312-636-9571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-06
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.011765101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor