Provider Demographics
NPI:1457622045
Name:POWELL, DAWNESHA (LCSW)
Entity Type:Individual
Prefix:
First Name:DAWNESHA
Middle Name:
Last Name:POWELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 W WASHINGTON AVE STE B
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-3731
Mailing Address - Country:US
Mailing Address - Phone:702-605-5858
Mailing Address - Fax:702-776-4841
Practice Address - Street 1:2500 W WASHINGTON AVE STE B
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-3731
Practice Address - Country:US
Practice Address - Phone:702-605-5858
Practice Address - Fax:702-776-4841
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-13
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7894-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100526939Medicaid