Provider Demographics
NPI:1164233102
Name:DANNA, ANGELINA VIVIAN LEIGH
Entity type:Individual
Prefix:
First Name:ANGELINA
Middle Name:VIVIAN LEIGH
Last Name:DANNA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:
Other - Last Name:DANNA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3587 HEATHROW WAY
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-4004
Mailing Address - Country:US
Mailing Address - Phone:541-858-8817
Mailing Address - Fax:541-858-8167
Practice Address - Street 1:210 COVE RD
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:OR
Practice Address - Zip Code:97415-2520
Practice Address - Country:US
Practice Address - Phone:541-469-0222
Practice Address - Fax:541-469-0228
Is Sole Proprietor?:No
Enumeration Date:2025-01-17
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health