Provider Demographics
NPI:1720782832
Name:DAWSON, MARY EMELINE (ALC)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:EMELINE
Last Name:DAWSON
Suffix:
Gender:F
Credentials:ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35214-2927
Mailing Address - Country:US
Mailing Address - Phone:225-315-8405
Mailing Address - Fax:
Practice Address - Street 1:9064 HELENA RD
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:AL
Practice Address - Zip Code:35124-2737
Practice Address - Country:US
Practice Address - Phone:205-644-1166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-30
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALALC04024101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor