Provider Demographics
NPI:1154630879
Name:WILSON, DAWN WALTON (MSW, ACSW, LCSW, NSW)
Entity Type:Individual
Prefix:MS
First Name:DAWN
Middle Name:WALTON
Last Name:WILSON
Suffix:
Gender:F
Credentials:MSW, ACSW, LCSW, NSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 921
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:24426-0921
Mailing Address - Country:US
Mailing Address - Phone:540-747-2495
Mailing Address - Fax:540-747-2789
Practice Address - Street 1:2708 POTTS CREED RD.
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:VA
Practice Address - Zip Code:24426
Practice Address - Country:US
Practice Address - Phone:540-747-2495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-29
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904003169104100000X
WVCP00941017104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker