Provider Demographics
NPI:1881202653
Name:DANA, CARLY ANNE (LPC)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:ANNE
Last Name:DANA
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 1:1021 S RIDGELINE DR
Mailing Address - Street 2:
Mailing Address - City:SHOW LOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85901-9589
Mailing Address - Country:US
Mailing Address - Phone:928-242-3814
Mailing Address - Fax:
Practice Address - Street 1:2051 EVERGREEN LN STE B
Practice Address - Street 2:
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-7928
Practice Address - Country:US
Practice Address - Phone:928-537-6941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-17
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-19081101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional