Provider Demographics
NPI:1497012660
Name:GAILEN, DAWN MARIE (MSC/MFCT)
Entity Type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:MARIE
Last Name:GAILEN
Suffix:
Gender:F
Credentials:MSC/MFCT
Other - Prefix:MRS
Other - First Name:DAWN
Other - Middle Name:MARIE
Other - Last Name:SACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSC/MFCT
Mailing Address - Street 1:1307 W 6TH ST STE 109
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-1642
Mailing Address - Country:US
Mailing Address - Phone:951-279-8333
Mailing Address - Fax:
Practice Address - Street 1:1307 W 6TH ST STE 109
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-1642
Practice Address - Country:US
Practice Address - Phone:951-279-8333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-12
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health