Provider Demographics
NPI:1033546429
Name:DAWSON, JESSIE (MA)
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:
Last Name:DAWSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1019 W 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28052-3961
Mailing Address - Country:US
Mailing Address - Phone:757-339-1149
Mailing Address - Fax:
Practice Address - Street 1:1019 W 6TH AVE
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28052-3961
Practice Address - Country:US
Practice Address - Phone:757-339-1149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-01
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA10461101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health