Provider Demographics
NPI:1538513502
Name:DAWSON, CARISSA CALLIE (AS)
Entity Type:Individual
Prefix:MRS
First Name:CARISSA
Middle Name:CALLIE
Last Name:DAWSON
Suffix:
Gender:F
Credentials:AS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 4TH ST
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95695-3501
Mailing Address - Country:US
Mailing Address - Phone:530-662-2699
Mailing Address - Fax:530-662-6918
Practice Address - Street 1:285 4TH ST
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-3501
Practice Address - Country:US
Practice Address - Phone:530-662-2699
Practice Address - Fax:530-662-6918
Is Sole Proprietor?:No
Enumeration Date:2016-04-15
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)