Provider Demographics
NPI:1417398116
Name:DAWSON, HEAVENLY RENEE (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:HEAVENLY
Middle Name:RENEE
Last Name:DAWSON
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 SEDGEMOOR RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-0376
Mailing Address - Country:US
Mailing Address - Phone:252-207-6896
Mailing Address - Fax:
Practice Address - Street 1:1515 DRAKESTONE CT
Practice Address - Street 2:UNIT 5
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-3486
Practice Address - Country:US
Practice Address - Phone:252-207-6896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-10
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0081021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical