Provider Demographics
NPI:1770087082
Name:ANTRIM, DAWN EILEEN (AMFT #142968)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:EILEEN
Last Name:ANTRIM
Suffix:
Gender:F
Credentials:AMFT #142968
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6121 CAMEO DR
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-4704
Mailing Address - Country:US
Mailing Address - Phone:661-916-4074
Mailing Address - Fax:
Practice Address - Street 1:9343 TECH CENTER DR STE 175
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-2592
Practice Address - Country:US
Practice Address - Phone:916-270-5945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-21
Last Update Date:2025-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA142968106H00000X
390200000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program