Provider Demographics
NPI:1275940876
Name:ELDRIDGE, DAWN MARIE-CHASITY (LMSW)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:MARIE-CHASITY
Last Name:ELDRIDGE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:
Other - Last Name:ENGMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:310 GLOCHESKI DR
Mailing Address - Street 2:
Mailing Address - City:MANISTEE
Mailing Address - State:MI
Mailing Address - Zip Code:49660-2639
Mailing Address - Country:US
Mailing Address - Phone:877-398-2013
Mailing Address - Fax:
Practice Address - Street 1:6051 FRANKFORT HWY
Practice Address - Street 2:
Practice Address - City:BENZONIA
Practice Address - State:MI
Practice Address - Zip Code:49616-9558
Practice Address - Country:US
Practice Address - Phone:877-398-2013
Practice Address - Fax:231-882-2195
Is Sole Proprietor?:No
Enumeration Date:2014-07-15
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801096606104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker