Provider Demographics
NPI:1750792719
Name:KIEWITT, DAWN (LPC NCC)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:KIEWITT
Suffix:
Gender:F
Credentials:LPC NCC
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:DENISE
Other - Last Name:MITRU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC NCC
Mailing Address - Street 1:5504 CHATHAM LN
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-9742
Mailing Address - Country:US
Mailing Address - Phone:810-625-4789
Mailing Address - Fax:
Practice Address - Street 1:901 CHIPPEWA ST
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-1552
Practice Address - Country:US
Practice Address - Phone:810-232-9950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-13
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401012103101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor