Provider Demographics
NPI:1457034134
Name:DAWSON, TABITHA HOPE
Entity Type:Individual
Prefix:
First Name:TABITHA
Middle Name:HOPE
Last Name:DAWSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4204 ESCAPE DR APT 301
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49006-6754
Mailing Address - Country:US
Mailing Address - Phone:810-990-9303
Mailing Address - Fax:
Practice Address - Street 1:1714 COMFORT ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48915-1511
Practice Address - Country:US
Practice Address - Phone:810-990-9303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician