Provider Demographics
NPI:1457421760
Name:DAWKINS, MARVA PHYLLIS (PHD)
Entity Type:Individual
Prefix:
First Name:MARVA
Middle Name:PHYLLIS
Last Name:DAWKINS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 W RANDOLPH ST STE 830
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-1815
Mailing Address - Country:US
Mailing Address - Phone:312-236-1498
Mailing Address - Fax:
Practice Address - Street 1:205 W RANDOLPH ST STE 830
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60606-1815
Practice Address - Country:US
Practice Address - Phone:312-236-1498
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-002053103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical