Provider Demographics
NPI:1568796480
Name:OWENS, DAWN G (LCSW)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:G
Last Name:OWENS
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 1:1104 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:NC
Mailing Address - Zip Code:28340-1444
Mailing Address - Country:US
Mailing Address - Phone:910-316-8153
Mailing Address - Fax:
Practice Address - Street 1:601 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:NC
Practice Address - Zip Code:28340-2041
Practice Address - Country:US
Practice Address - Phone:910-316-8153
Practice Address - Fax:888-280-9562
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-24
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0064391041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6007426Medicaid