Provider Demographics
NPI:1669779450
Name:DAVIS-BRODEUR, DAWN K (MA, LCPC)
Entity type:Individual
Prefix:MS
First Name:DAWN
Middle Name:K
Last Name:DAVIS-BRODEUR
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6374 WOODBURN AVE
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-5833
Mailing Address - Country:US
Mailing Address - Phone:410-926-8826
Mailing Address - Fax:
Practice Address - Street 1:1332 DONALD AVE
Practice Address - Street 2:
Practice Address - City:SEVERN
Practice Address - State:MD
Practice Address - Zip Code:21144-2630
Practice Address - Country:US
Practice Address - Phone:410-770-5096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-15
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC3804101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional