Provider Demographics
NPI:1083806483
Name:DAWN R. REESE, PH.D., PLC
Entity Type:Organization
Organization Name:DAWN R. REESE, PH.D., PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:R
Authorized Official - Last Name:GRIMSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-591-2300
Mailing Address - Street 1:705 MOBJACK PL
Mailing Address - Street 2:SUITE C
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-1966
Mailing Address - Country:US
Mailing Address - Phone:757-591-2300
Mailing Address - Fax:757-591-2130
Practice Address - Street 1:705 MOBJACK PL
Practice Address - Street 2:SUITE C
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-1966
Practice Address - Country:US
Practice Address - Phone:757-591-2300
Practice Address - Fax:757-591-2130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-10
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810002415103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC08563Medicare PIN