Provider Demographics
NPI:1154673127
Name:DAWSON, LISA IRENE (LCSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:IRENE
Last Name:DAWSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 EF THOMPKINS LN
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-6001
Mailing Address - Country:US
Mailing Address - Phone:252-571-2661
Mailing Address - Fax:
Practice Address - Street 1:1304 COMMERCE DR
Practice Address - Street 2:SUITE C
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-2212
Practice Address - Country:US
Practice Address - Phone:252-637-4673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-15
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0092131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical