Provider Demographics
NPI:1912354523
Name:DAWN M NEELY MSW LICSW PLLC
Entity Type:Organization
Organization Name:DAWN M NEELY MSW LICSW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:NEELY
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:304-290-8138
Mailing Address - Street 1:874 FAIRMONT RD STE C
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26501-3893
Mailing Address - Country:US
Mailing Address - Phone:304-290-8138
Mailing Address - Fax:304-598-0473
Practice Address - Street 1:874 FAIRMONT RD
Practice Address - Street 2:SUITE C
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26501
Practice Address - Country:US
Practice Address - Phone:304-290-8138
Practice Address - Fax:304-598-0473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-24
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVDP00941909104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty