Provider Demographics
NPI:1164669644
Name:DOBSON, SHAWNA ELIZABETH (MA LPCC)
Entity Type:Individual
Prefix:
First Name:SHAWNA
Middle Name:ELIZABETH
Last Name:DOBSON
Suffix:
Gender:F
Credentials:MA LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:361 3RD ST
Mailing Address - Street 2:SUITE G
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-3541
Mailing Address - Country:US
Mailing Address - Phone:415-258-4944
Mailing Address - Fax:
Practice Address - Street 1:361 3RD ST
Practice Address - Street 2:SUITE G
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-3541
Practice Address - Country:US
Practice Address - Phone:415-258-4944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-21
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2651101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004040655Medicaid