Provider Demographics
NPI:1891198750
Name:DANNA, NICOLE A (MSMFT)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:A
Last Name:DANNA
Suffix:
Gender:F
Credentials:MSMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5133 SADDLE CIR
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-4893
Mailing Address - Country:US
Mailing Address - Phone:847-924-0925
Mailing Address - Fax:
Practice Address - Street 1:302 BASTON RD
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-2906
Practice Address - Country:US
Practice Address - Phone:706-447-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-06
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI332-228106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist