Provider Demographics
NPI:1184175788
Name:WEBER, DAYNA RUTH (LPC)
Entity type:Individual
Prefix:MRS
First Name:DAYNA
Middle Name:RUTH
Last Name:WEBER
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 1:1495 W WEST MAPLE RD APT 123
Mailing Address - Street 2:
Mailing Address - City:WALLED LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48390-2907
Mailing Address - Country:US
Mailing Address - Phone:248-949-4484
Mailing Address - Fax:
Practice Address - Street 1:30706 TAMARACK ST
Practice Address - Street 2:APT 38111
Practice Address - City:WIXOM
Practice Address - State:MI
Practice Address - Zip Code:48393-2728
Practice Address - Country:US
Practice Address - Phone:248-949-4484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-18
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401017217101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor