Provider Demographics
NPI:1326721481
Name:HUTCHINS EASTMAN, DAWN
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:HUTCHINS EASTMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:HUTCHINS
Other - Last Name:EASTMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMHC
Mailing Address - Street 1:173 FORESTRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:SUNRISE BEACH
Mailing Address - State:MO
Mailing Address - Zip Code:65079-9268
Mailing Address - Country:US
Mailing Address - Phone:920-716-6777
Mailing Address - Fax:
Practice Address - Street 1:9301 INDIAN SCHOOL RD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-2884
Practice Address - Country:US
Practice Address - Phone:505-218-6383
Practice Address - Fax:505-636-6338
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCTB-2023-0681101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty