Provider Demographics
NPI:1356708218
Name:PHILLIPS, DANA KRISTINE (LPC, NCC, SAC,MA)
Entity type:Individual
Prefix:MRS
First Name:DANA
Middle Name:KRISTINE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LPC, NCC, SAC,MA
Other - Prefix:MISS
Other - First Name:DANA
Other - Middle Name:KRISTINE
Other - Last Name:LOGANDRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC, NCC, SAC,MA
Mailing Address - Street 1:630 CLEMENTS BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08007-1814
Mailing Address - Country:US
Mailing Address - Phone:856-617-4267
Mailing Address - Fax:
Practice Address - Street 1:630 CLEMENTS BRIDGE RD
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08007-1814
Practice Address - Country:US
Practice Address - Phone:856-617-4267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-24
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00477200101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional