Healthcare Provider Details

I. General information

NPI: 1679197768
Provider Name (Legal Business Name): DASHEKA ARKON MORRIS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2020
Last Update Date: 06/03/2020
Certification Date: 06/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4920 E STATE ST
ROCKFORD IL
61108-2272
US

IV. Provider business mailing address

3411 CORBRIDGE LN
ROCKFORD IL
61107-3530
US

V. Phone/Fax

Practice location:
  • Phone: 608-280-2095
  • Fax:
Mailing address:
  • Phone: 815-238-4160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149015309
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: