Provider Demographics
NPI:1124621230
Name:HARDISON-DUKE, DANA JELYNN (MA, LCMHC, NCC)
Entity type:Individual
Prefix:MS
First Name:DANA
Middle Name:JELYNN
Last Name:HARDISON-DUKE
Suffix:
Gender:F
Credentials:MA, LCMHC, NCC
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:
Other - Last Name:DUKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LCMHC, NCC
Mailing Address - Street 1:608 LILLIPUT DR
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-9067
Mailing Address - Country:US
Mailing Address - Phone:256-349-8430
Mailing Address - Fax:252-513-5073
Practice Address - Street 1:3012 TRENT RD #6
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-5735
Practice Address - Country:US
Practice Address - Phone:256-349-8430
Practice Address - Fax:252-513-5073
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-19
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16125101YM0800X, 101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1124621230Medicaid
NCA16125OtherNORTH CAROLINA BOARD OF CLINICAL MENTAL HEALTH COUNSELORS
NC1532630OtherNATIONAL BOARD OF CERTIFIED COUNSELORS
NC16125OtherNORTH CAROLINA BOARD OF CLINICAL MENTAL HEALTH COUNSELORS