Provider Demographics
NPI:1306989710
Name:PINA, DAKESA DAWN (PHD, LMFT)
Entity type:Individual
Prefix:DR
First Name:DAKESA
Middle Name:DAWN
Last Name:PINA
Suffix:
Gender:F
Credentials:PHD, LMFT
Other - Prefix:DR
Other - First Name:DAKESA
Other - Middle Name:DAWN
Other - Last Name:SCHOOLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, LMFT
Mailing Address - Street 1:2003 INTERURBAN RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61705-5103
Mailing Address - Country:US
Mailing Address - Phone:806-928-2420
Mailing Address - Fax:
Practice Address - Street 1:705 E LINCOLN ST STE 116
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-6406
Practice Address - Country:US
Practice Address - Phone:309-431-1442
Practice Address - Fax:309-753-0031
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5009106H00000X
IL166.000739106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1608937-01Medicaid