Provider Demographics
NPI:1689863730
Name:DAWSON-BLACK, PATRICIA ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:ANN
Last Name:DAWSON-BLACK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:PAT
Other - Middle Name:
Other - Last Name:BLACK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:914 WEST FM 517
Mailing Address - Street 2:SUITE 215
Mailing Address - City:DICKINSON
Mailing Address - State:TX
Mailing Address - Zip Code:77539-3923
Mailing Address - Country:US
Mailing Address - Phone:281-435-2581
Mailing Address - Fax:281-996-9411
Practice Address - Street 1:914 WEST FM 517
Practice Address - Street 2:SUITE 215
Practice Address - City:DICKINSON
Practice Address - State:TX
Practice Address - Zip Code:77539-3923
Practice Address - Country:US
Practice Address - Phone:281-435-2581
Practice Address - Fax:281-996-9411
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-15
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24829103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical