Provider Demographics
NPI:1609402510
Name:COLLEY, DAWN M (LSW)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:M
Last Name:COLLEY
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 TROVATO ST STE 103
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-7286
Mailing Address - Country:US
Mailing Address - Phone:304-623-6300
Mailing Address - Fax:304-623-6302
Practice Address - Street 1:27 TROVATO ST STE 103
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-7286
Practice Address - Country:US
Practice Address - Phone:304-623-6300
Practice Address - Fax:304-623-6302
Is Sole Proprietor?:No
Enumeration Date:2020-03-23
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor