Provider Demographics
NPI:1215304365
Name:SPELL, DASHA (LPC,NCC)
Entity type:Individual
Prefix:MS
First Name:DASHA
Middle Name:
Last Name:SPELL
Suffix:
Gender:F
Credentials:LPC,NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 GOLDEN HILL ST
Mailing Address - Street 2:APT 406
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06604-4117
Mailing Address - Country:US
Mailing Address - Phone:203-243-6325
Mailing Address - Fax:
Practice Address - Street 1:144 GOLDEN HILL ST
Practice Address - Street 2:APT 406
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06604-4117
Practice Address - Country:US
Practice Address - Phone:203-342-6325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-25
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002786101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional