Healthcare Provider Details

I. General information

NPI: 1093285009
Provider Name (Legal Business Name): DAKOTAH STORAY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2018
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16200 SAND CANYON AVE
IRVINE CA
92618-3714
US

IV. Provider business mailing address

13406 HERITAGE WAY
TUSTIN CA
92782-9134
US

V. Phone/Fax

Practice location:
  • Phone: 949-764-4624
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number138172
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: