Provider Demographics
NPI:1518715622
Name:DAHN, VANESSA LEE
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:LEE
Last Name:DAHN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 BROOK LN
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN
Mailing Address - State:ME
Mailing Address - Zip Code:04664-3147
Mailing Address - Country:US
Mailing Address - Phone:207-266-9295
Mailing Address - Fax:
Practice Address - Street 1:24 BROOK LN
Practice Address - Street 2:
Practice Address - City:SULLIVAN
Practice Address - State:ME
Practice Address - Zip Code:04664-3147
Practice Address - Country:US
Practice Address - Phone:207-266-9295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPC5239101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional