Provider Demographics
NPI:1265867436
Name:HANSON, DAWN MICHELLE
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:MICHELLE
Last Name:HANSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21017 WILBEAM AVE
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-5812
Mailing Address - Country:US
Mailing Address - Phone:757-286-8776
Mailing Address - Fax:
Practice Address - Street 1:333 HEGENBERGER RD
Practice Address - Street 2:600
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94621-1420
Practice Address - Country:US
Practice Address - Phone:510-383-1626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-06
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health