Basic Information
| Provider Information | |||||||||
| NPI: | 1770775769 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAWSON | ||||||||
| FirstName: | DOUG | ||||||||
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| Credential: | PCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 899 E BROAD ST 3RD FL | ||||||||
| Address2: | CHILDREN'S HOSPITAL GUIDANCE CENTERQ | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6143558000 | ||||||||
| FaxNumber: | 6143558018 | ||||||||
| Practice Location | |||||||||
| Address1: | 899 E BROAD ST 3RD FL | ||||||||
| Address2: | CHILDREN'S HOSPITAL GUIDANCE CENTERQ | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6143558000 | ||||||||
| FaxNumber: | 6143558018 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2007 | ||||||||
| LastUpdateDate: | 08/02/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | E0003796 | OH | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 2846675 | 05 | OH | MEDICAID | 0205231 | 05 | OH | MEDICAID |