Provider Demographics
NPI:1811102858
Name:DAWKINS, ANDREA D (MA CAP ICADC NCACIP)
Entity type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:D
Last Name:DAWKINS
Suffix:
Gender:F
Credentials:MA CAP ICADC NCACIP
Other - Prefix:MS
Other - First Name:DAWN
Other - Middle Name:
Other - Last Name:DAWKINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA CAP ICADC NCACIP
Mailing Address - Street 1:2294 NEWMARK DR
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32738-6214
Mailing Address - Country:US
Mailing Address - Phone:407-603-3579
Mailing Address - Fax:407-495-5709
Practice Address - Street 1:2640 HIAWATHA AVE
Practice Address - Street 2:SUITE E
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32773-5342
Practice Address - Country:US
Practice Address - Phone:407-603-3579
Practice Address - Fax:407-495-5709
Is Sole Proprietor?:No
Enumeration Date:2007-05-12
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4270101YM0800X, 101YA0400X, 171M00000X
OK101YP1600X, 101Y00000X
FL174V00000X
FL120578174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No174V00000XOther Service ProvidersClinical Ethicist
No174400000XOther Service ProvidersSpecialist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor