Provider Demographics
NPI:1770075228
Name:DASHER, WALLACE III (MS)
Entity type:Individual
Prefix:MR
First Name:WALLACE
Middle Name:
Last Name:DASHER
Suffix:III
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 FRIARS LN
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-3459
Mailing Address - Country:US
Mailing Address - Phone:941-404-8382
Mailing Address - Fax:248-769-6154
Practice Address - Street 1:1703 W COLONIAL DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-7000
Practice Address - Country:US
Practice Address - Phone:321-332-8211
Practice Address - Fax:248-769-6154
Is Sole Proprietor?:No
Enumeration Date:2018-05-31
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst