Provider Demographics
NPI:1417567041
Name:SAHUALLA, DAWN EMB (LCSW)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:EMB
Last Name:SAHUALLA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2440 CRAWFORD DR
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70611-4654
Mailing Address - Country:US
Mailing Address - Phone:337-405-8984
Mailing Address - Fax:
Practice Address - Street 1:2440 CRAWFORD DR
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70611-4654
Practice Address - Country:US
Practice Address - Phone:337-405-8984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-07
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA90171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA9017OtherLICENSING BOARD