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General NPI Number Information
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NPI Number | 1720585201
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Entity Type | Individual
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Provider Name | DANA RAE CONNOR PH.D.
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Gender | Female
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Dates
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Enumeration Date | 04/10/2018
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Last Update Date | 04/10/2018
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Provider Practice Location Address
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Address Line | 1 FORD PL STE 1E
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City | DETROIT
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State | MI
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Zip | 48202-3450
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Country | US
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Telephone | 313-876-2526
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Fax | 313-876-2279
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Provider Business Mailing Address
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Address Line | 1321 ORLEANS ST APT 1611
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City | DETROIT
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State | MI
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Zip | 48207-2950
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Country | US
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Telephone | 586-202-9233
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Fax |
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6301017388
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License Number State | MI
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