Provider Demographics
NPI:1972256725
Name:CORMIER, DANAE KRISTEN
Entity type:Individual
Prefix:
First Name:DANAE
Middle Name:KRISTEN
Last Name:CORMIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92703-2101
Mailing Address - Country:US
Mailing Address - Phone:714-972-1402
Mailing Address - Fax:
Practice Address - Street 1:1225 W 6TH ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92703-2101
Practice Address - Country:US
Practice Address - Phone:714-972-1402
Practice Address - Fax:562-987-4586
Is Sole Proprietor?:No
Enumeration Date:2022-02-01
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASUDCC-17151101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA191989Medicaid