Provider Demographics
NPI:1760919112
Name:WHITE, DANA WATSON (CPSS)
Entity Type:Individual
Prefix:MRS
First Name:DANA
Middle Name:WATSON
Last Name:WHITE
Suffix:
Gender:F
Credentials:CPSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 HOLLAND DR
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28677-4168
Mailing Address - Country:US
Mailing Address - Phone:704-641-8199
Mailing Address - Fax:
Practice Address - Street 1:327 HOLLAND DR
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-4168
Practice Address - Country:US
Practice Address - Phone:704-641-8199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2017-3928-01175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist