Provider Demographics
NPI:1942783485
Name:MCCARROLL, DANA
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:MCCARROLL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 RHODE ISLAND ST
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48203-3358
Mailing Address - Country:US
Mailing Address - Phone:702-619-9337
Mailing Address - Fax:
Practice Address - Street 1:147 RHODE ISLAND ST
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:MI
Practice Address - Zip Code:48203-3358
Practice Address - Country:US
Practice Address - Phone:702-619-9337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-11
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1744G0900X
373H00000X, 221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
No1744G0900XOther Service ProvidersSpecialistGraphics DesignerGroup - Multi-Specialty
No373H00000XNursing Service Related ProvidersDay Training/Habilitation SpecialistGroup - Multi-Specialty