Provider Demographics
NPI:1255972147
Name:MOORE, DAWNYEL (CSW)
Entity type:Individual
Prefix:
First Name:DAWNYEL
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 W COLFAX AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46601-1695
Mailing Address - Country:US
Mailing Address - Phone:574-546-1900
Mailing Address - Fax:574-248-4074
Practice Address - Street 1:220 W COLFAX AVE
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1695
Practice Address - Country:US
Practice Address - Phone:574-546-1900
Practice Address - Fax:574-248-4074
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-02
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY51561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical