Provider Demographics
NPI:1952638561
Name:WARNER, DAWN (MA,NCC,LMHC)
Entity Type:Individual
Prefix:MS
First Name:DAWN
Middle Name:
Last Name:WARNER
Suffix:
Gender:F
Credentials:MA,NCC,LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 SOUTH WASHINGTON AVE,
Mailing Address - Street 2:SUITE D
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32780-4292
Mailing Address - Country:US
Mailing Address - Phone:321-567-4903
Mailing Address - Fax:321-567-4904
Practice Address - Street 1:1313 SOUTH WASHINGTON AVE,
Practice Address - Street 2:SUITE D
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32780-4292
Practice Address - Country:US
Practice Address - Phone:321-567-4903
Practice Address - Fax:321-567-4904
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-03
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6253101YM0800X
FL10175101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL27-1367634OtherTAX ID
12021770OtherCAQH