Provider Demographics
NPI:1487015111
Name:DAWSON, JUSTIN (LICSW, CDP)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:DAWSON
Suffix:
Gender:M
Credentials:LICSW, CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 ROCKEFELLER AVE
Mailing Address - Street 2:M/S 305
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-4046
Mailing Address - Country:US
Mailing Address - Phone:425-388-7215
Mailing Address - Fax:
Practice Address - Street 1:3000 ROCKEFELLER AVE
Practice Address - Street 2:M/S 305
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4046
Practice Address - Country:US
Practice Address - Phone:425-388-7215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-08
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW60294752104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker