Provider Demographics
NPI:1508005703
Name:SIAS, DAWN RENEE (LPC)
Entity Type:Individual
Prefix:MISS
First Name:DAWN
Middle Name:RENEE
Last Name:SIAS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 342
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:38935-0342
Mailing Address - Country:US
Mailing Address - Phone:601-383-2920
Mailing Address - Fax:601-767-3400
Practice Address - Street 1:215 W FRONT ST
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:MS
Practice Address - Zip Code:38930-4400
Practice Address - Country:US
Practice Address - Phone:662-299-0342
Practice Address - Fax:601-767-3400
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-11
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1355101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS64-0535588Medicaid