Provider Demographics
NPI:1386967198
Name:AVERY, DADRA LEI (MS, LPC, NCC)
Entity type:Individual
Prefix:MRS
First Name:DADRA
Middle Name:LEI
Last Name:AVERY
Suffix:
Gender:F
Credentials:MS, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1317 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:STURGIS
Mailing Address - State:SD
Mailing Address - Zip Code:57785-2754
Mailing Address - Country:US
Mailing Address - Phone:605-210-2404
Mailing Address - Fax:
Practice Address - Street 1:3820 JACKSON BLVD
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-3202
Practice Address - Country:US
Practice Address - Phone:188-886-8423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-08
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPC7095101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDLPC7095OtherLPC