Provider Demographics
NPI:1376654400
Name:DAWSON, KATHRYN E (LIC PSYC)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:E
Last Name:DAWSON
Suffix:
Gender:F
Credentials:LIC PSYC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1612 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25703-1408
Mailing Address - Country:US
Mailing Address - Phone:304-634-0668
Mailing Address - Fax:
Practice Address - Street 1:1612 6TH AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25703-1408
Practice Address - Country:US
Practice Address - Phone:304-634-0668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV900103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV9262581OtherMEDICARE GROUP