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General NPI Number Information
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NPI Number | 1194152009
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Entity Type | Individual
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Provider Name | MARLA JOY DANN LCSW
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Gender | Female
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Dates
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Enumeration Date | 10/09/2013
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Last Update Date | 10/09/2013
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Provider Practice Location Address
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Address Line | 404 W 25TH ST
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City | SANFORD
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State | FL
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Zip | 32771-4422
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Country | US
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Telephone | 407-322-7779
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Fax | 407-322-7795
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Provider Business Mailing Address
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Address Line | 404 W 25TH ST.
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City | SANFORD
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State | FL
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Zip | 32771
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Country | US
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Telephone | 407-322-7779
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Fax | 407-322-7795
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CAP 2074
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW8606
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License Number State | FL
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