Provider Demographics
NPI:1013378850
Name:DAWN WOOD COUNSELING, LLC
Entity Type:Organization
Organization Name:DAWN WOOD COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:LLMSW
Authorized Official - Phone:269-808-0160
Mailing Address - Street 1:1918 STEARNS AVE
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-1844
Mailing Address - Country:US
Mailing Address - Phone:269-808-0160
Mailing Address - Fax:
Practice Address - Street 1:3503 GREENLEAF BLVD STE 202
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-2580
Practice Address - Country:US
Practice Address - Phone:269-808-0160
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-07
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
MI68010962071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0C90618OtherBLUE CROSS BLUE SHIELD, BLUE CARE NETWORK OF MICHIGAN