Provider Demographics
NPI:1740906155
Name:DAWSON, DOUGLAS JAY (SUDP)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:JAY
Last Name:DAWSON
Suffix:
Gender:M
Credentials:SUDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 S THOR ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-4855
Mailing Address - Country:US
Mailing Address - Phone:509-532-2000
Mailing Address - Fax:509-532-2005
Practice Address - Street 1:22 S THOR ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-4855
Practice Address - Country:US
Practice Address - Phone:509-532-2000
Practice Address - Fax:509-532-2005
Is Sole Proprietor?:No
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP603344743101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)