Provider Demographics
NPI:1720684459
Name:DUGGER, DANIEL CHRISTOPHER-HAGE
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:CHRISTOPHER-HAGE
Last Name:DUGGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4117 PARKRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-7600
Mailing Address - Country:US
Mailing Address - Phone:612-840-0570
Mailing Address - Fax:
Practice Address - Street 1:6160 SUMMIT DR N STE 375
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55430-2251
Practice Address - Country:US
Practice Address - Phone:763-560-8331
Practice Address - Fax:763-560-8431
Is Sole Proprietor?:No
Enumeration Date:2020-12-08
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MNCC03388101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health