Provider Demographics
NPI:1780427393
Name:SMITH, DAWNIELLE L (LCSW)
Entity type:Individual
Prefix:
First Name:DAWNIELLE
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2788 DEFOORS FERRY RD NW APT 411
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-2144
Mailing Address - Country:US
Mailing Address - Phone:708-846-6163
Mailing Address - Fax:
Practice Address - Street 1:657 MELROSE LN APT 1
Practice Address - Street 2:
Practice Address - City:BEECHER
Practice Address - State:IL
Practice Address - Zip Code:60401-3658
Practice Address - Country:US
Practice Address - Phone:708-846-6163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490265391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical