Provider Demographics
NPI:1780879577
Name:NUGENT, DANA ADRIENNE (EDD)
Entity type:Individual
Prefix:MRS
First Name:DANA
Middle Name:ADRIENNE
Last Name:NUGENT
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 44
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:WV
Mailing Address - Zip Code:26260-0044
Mailing Address - Country:US
Mailing Address - Phone:307-257-8232
Mailing Address - Fax:304-866-4342
Practice Address - Street 1:1200 HARRISON AVE
Practice Address - Street 2:STE 121
Practice Address - City:DAVIS
Practice Address - State:WV
Practice Address - Zip Code:26260-0044
Practice Address - Country:US
Practice Address - Phone:304-257-8232
Practice Address - Fax:304-866-4342
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-13
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC004416101YP2500X
WV999103T00000X
WV1843101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810017759Medicaid