Provider Demographics
NPI:1720585201
Name:CONNOR, DANA RAE (PHD)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:RAE
Last Name:CONNOR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 ORLEANS ST APT 1611
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48207-2950
Mailing Address - Country:US
Mailing Address - Phone:586-202-9233
Mailing Address - Fax:
Practice Address - Street 1:1 FORD PL STE 1E
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-3450
Practice Address - Country:US
Practice Address - Phone:313-876-2526
Practice Address - Fax:313-876-2279
Is Sole Proprietor?:No
Enumeration Date:2018-04-10
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301017388103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical