Provider Demographics
NPI:1821082397
Name:REESE, DAWN R (PHD)
Entity Type:Individual
Prefix:MS
First Name:DAWN
Middle Name:R
Last Name:REESE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 LOCUST RUN
Mailing Address - Street 2:
Mailing Address - City:POQUOSON
Mailing Address - State:VA
Mailing Address - Zip Code:23662-2239
Mailing Address - Country:US
Mailing Address - Phone:757-868-6072
Mailing Address - Fax:
Practice Address - Street 1:705 MOBJACK PL
Practice Address - Street 2:SUITE C
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-1966
Practice Address - Country:US
Practice Address - Phone:757-591-2300
Practice Address - Fax:757-591-2130
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-09
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810002415103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA461293OtherANTHEM
VA007714068Medicaid
VA798985OtherVALUE OPTIONS
VA230597OtherMHN
VA486705OtherMAMSI
VA461293OtherANTHEM
VA798985OtherVALUE OPTIONS