Provider Demographics
NPI:1679052385
Name:GRAWE, DANA (LPCC-S)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:GRAWE
Suffix:
Gender:
Credentials:LPCC-S
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:
Other - Last Name:BURGHARDT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPCC-S
Mailing Address - Street 1:10200 ALLIANCE RD STE 150
Mailing Address - Street 2:
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45242-4754
Mailing Address - Country:US
Mailing Address - Phone:513-891-0650
Mailing Address - Fax:
Practice Address - Street 1:10200 ALLIANCE RD STE 150
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-4754
Practice Address - Country:US
Practice Address - Phone:513-891-0650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-13
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.2102621-SUPV101YP2500X, 101Y00000X
OHE.2102621101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0310190Medicaid