Provider Demographics
NPI:1336227487
Name:PAINE, DANA J (LPCC)
Entity Type:Individual
Prefix:MR
First Name:DANA
Middle Name:J
Last Name:PAINE
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:A PATH
Other - Middle Name:WITH
Other - Last Name:HEART
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:920 CARDENAS DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-1720
Mailing Address - Country:US
Mailing Address - Phone:505-266-8166
Mailing Address - Fax:
Practice Address - Street 1:920 CARDENAS DR NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-1720
Practice Address - Country:US
Practice Address - Phone:505-266-8166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0095841101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM202008008OtherPRESBYTERIAN PROVIDER ID