Provider Demographics
NPI:1053749432
Name:DUNAHEE, DARREN (MBA, MSW, LCSW)
Entity type:Individual
Prefix:
First Name:DARREN
Middle Name:
Last Name:DUNAHEE
Suffix:
Gender:M
Credentials:MBA, MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1289 CEDAR CREEK LN
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:IL
Mailing Address - Zip Code:62801-9013
Mailing Address - Country:US
Mailing Address - Phone:618-315-2770
Mailing Address - Fax:
Practice Address - Street 1:2921 MARYVILLE RD STE B
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62062-5400
Practice Address - Country:US
Practice Address - Phone:618-484-9337
Practice Address - Fax:618-484-9353
Is Sole Proprietor?:No
Enumeration Date:2013-10-23
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490145181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL149.014518OtherSTATE LICENSE NUMBER