Basic Information
| Provider Information | |||||||||
| NPI: | 1730782277 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAWSON | ||||||||
| FirstName: | ALLIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | DPT 781625 | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482780001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6143558004 | ||||||||
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| Practice Location | |||||||||
| Address1: | 399 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432155384 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6143558550 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/18/2020 | ||||||||
| LastUpdateDate: | 11/18/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/18/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | S.1901181-TRNE | N | Behavioral Health & Social Service Providers | Social Worker | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.