Provider Demographics
NPI:1932596673
Name:GRITTEN, DAWN MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:MARIE
Last Name:GRITTEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:M
Other - Last Name:DIXON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:318 4TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47932-1275
Mailing Address - Country:US
Mailing Address - Phone:765-791-8663
Mailing Address - Fax:765-299-0049
Practice Address - Street 1:318 4TH ST STE B
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:IN
Practice Address - Zip Code:47932-1275
Practice Address - Country:US
Practice Address - Phone:765-791-8663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-21
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34006760A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300049686Medicaid
IN13512368OtherCAQH