Provider Demographics
NPI:1689033060
Name:DAWN M. JETT, LCSW, LLC
Entity Type:Organization
Organization Name:DAWN M. JETT, LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:M
Authorized Official - Last Name:JETT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:706-951-2182
Mailing Address - Street 1:2641 RAYMOND AVE
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-5338
Mailing Address - Country:US
Mailing Address - Phone:706-951-2182
Mailing Address - Fax:
Practice Address - Street 1:3540 WHEELER RD STE 210
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-1879
Practice Address - Country:US
Practice Address - Phone:706-951-2182
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-15
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW003221251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health