Healthcare Provider Details

I. General information

NPI: 1295190767
Provider Name (Legal Business Name): DANA LEE DYKES MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2015
Last Update Date: 12/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7731 W NEWBERRY RD STE A1
GAINESVILLE FL
32606-9246
US

IV. Provider business mailing address

7731 W NEWBERRY RD STE A1
GAINESVILLE FL
32606-9246
US

V. Phone/Fax

Practice location:
  • Phone: 352-877-3413
  • Fax: 352-877-3414
Mailing address:
  • Phone: 352-877-3413
  • Fax: 352-877-3414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: