Provider Demographics
NPI:1871864801
Name:EAST-MCCOY, DAWNA (LHMC)
Entity Type:Individual
Prefix:MRS
First Name:DAWNA
Middle Name:
Last Name:EAST-MCCOY
Suffix:
Gender:F
Credentials:LHMC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 SOUTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:47362
Mailing Address - Country:US
Mailing Address - Phone:765-521-0426
Mailing Address - Fax:765-529-7269
Practice Address - Street 1:321 S MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:IN
Practice Address - Zip Code:47362-4218
Practice Address - Country:US
Practice Address - Phone:765-521-0426
Practice Address - Fax:765-529-7269
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-23
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39000128A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200077810AMedicaid