Provider Demographics
NPI:1346772464
Name:DAWSON, TINA (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:
Last Name:DAWSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 RIDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LA PLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068-6458
Mailing Address - Country:US
Mailing Address - Phone:985-703-0380
Mailing Address - Fax:
Practice Address - Street 1:58 RIDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-6458
Practice Address - Country:US
Practice Address - Phone:985-703-0380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-29
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA49220104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker