Provider Demographics
NPI:1780430389
Name:DAWSON, SHANNON (MS, RCMHI (PENDING))
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:
Last Name:DAWSON
Suffix:
Gender:F
Credentials:MS, RCMHI (PENDING)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 CELEBRATION BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-5162
Mailing Address - Country:US
Mailing Address - Phone:517-403-1174
Mailing Address - Fax:
Practice Address - Street 1:1420 CELEBRATION BLVD STE 200
Practice Address - Street 2:
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747-5162
Practice Address - Country:US
Practice Address - Phone:517-403-1174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-25
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health