Provider Demographics
NPI:1770775769
Name:DAWSON, DOUG (PCC)
Entity type:Individual
Prefix:
First Name:DOUG
Middle Name:
Last Name:DAWSON
Suffix:
Gender:M
Credentials:PCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:899 E BROAD ST 3RD FL
Mailing Address - Street 2:CHILDREN'S HOSPITAL GUIDANCE CENTERQ
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205
Mailing Address - Country:US
Mailing Address - Phone:614-355-8000
Mailing Address - Fax:614-355-8018
Practice Address - Street 1:899 E BROAD ST 3RD FL
Practice Address - Street 2:CHILDREN'S HOSPITAL GUIDANCE CENTERQ
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205
Practice Address - Country:US
Practice Address - Phone:614-355-8000
Practice Address - Fax:614-355-8018
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2017-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0003796101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2846675Medicaid
OH0205231Medicaid
OH2846675Medicaid