Provider Demographics
NPI:1679091441
Name:MAXWELL, D DAWN (MA CATC IV)
Entity Type:Individual
Prefix:MS
First Name:D
Middle Name:DAWN
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:MA CATC IV
Other - Prefix:
Other - First Name:D. DAWN
Other - Middle Name:
Other - Last Name:MAXWELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:27758 SANTA MARGARITA PKWY # 554
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6709
Mailing Address - Country:US
Mailing Address - Phone:949-701-1134
Mailing Address - Fax:
Practice Address - Street 1:30950 RANCHO VIEJO RD SUITE 225
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675
Practice Address - Country:US
Practice Address - Phone:949-701-1134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA168115IV101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA168115IVOtherACCBC (CAADE)