Provider Demographics
NPI:1003947094
Name:MCCOY, DAWN LOUISE (LISW)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:LOUISE
Last Name:MCCOY
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 BLUE VALLEY RD SE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-8367
Mailing Address - Country:US
Mailing Address - Phone:740-438-2946
Mailing Address - Fax:
Practice Address - Street 1:123 S BROAD ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-4304
Practice Address - Country:US
Practice Address - Phone:740-438-2946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI. 0008271101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health