Provider Demographics
NPI:1275158339
Name:DAVIS, DAWN MARTIN (LCSW)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:MARTIN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:MARIE
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2113 HIGHWAY 182
Mailing Address - Street 2:
Mailing Address - City:RACELAND
Mailing Address - State:LA
Mailing Address - Zip Code:70394-3163
Mailing Address - Country:US
Mailing Address - Phone:985-628-0511
Mailing Address - Fax:
Practice Address - Street 1:1421 GENERAL TAYLOR ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-3717
Practice Address - Country:US
Practice Address - Phone:504-894-1999
Practice Address - Fax:504-894-1111
Is Sole Proprietor?:No
Enumeration Date:2020-06-14
Last Update Date:2020-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA25281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2528OtherLA STATE BOARD SOCIAL WORK EXAMINERS