Provider Demographics
NPI:1851656540
Name:DAGUE, KELLY MARIE (MS)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:MARIE
Last Name:DAGUE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1513 CEDAR CLIFF DR STE 200
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-7721
Mailing Address - Country:US
Mailing Address - Phone:239-281-4349
Mailing Address - Fax:
Practice Address - Street 1:1513 CEDAR CLIFF DR STE 200
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-7721
Practice Address - Country:US
Practice Address - Phone:239-281-4349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-09
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAPC000695101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health