Provider Demographics
NPI:1760966485
Name:HANDA, DAWN MARIE (LCPC)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:MARIE
Last Name:HANDA
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 1:3905 4TH ST NE
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59404-4244
Mailing Address - Country:US
Mailing Address - Phone:406-788-6077
Mailing Address - Fax:
Practice Address - Street 1:321 1ST AVE N
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59401-2505
Practice Address - Country:US
Practice Address - Phone:406-478-6776
Practice Address - Fax:406-250-2396
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-18
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCPC-LIC-38449101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1760966485Medicaid