Provider Demographics
NPI:1669943817
Name:LANAVILLE, DAWN Y (PHD)
Entity type:Individual
Prefix:DR
First Name:DAWN
Middle Name:Y
Last Name:LANAVILLE
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 1:1851 W EHRINGHAUS ST
Mailing Address - Street 2:P.O. BOX 353
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-9723
Mailing Address - Country:US
Mailing Address - Phone:252-562-6072
Mailing Address - Fax:
Practice Address - Street 1:303 E. MAIN ST.
Practice Address - Street 2:SUITE 7
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-2790
Practice Address - Country:US
Practice Address - Phone:252-562-6072
Practice Address - Fax:252-562-6013
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-16
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5473103TC0700X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1770181OtherSOSID