Provider Demographics
NPI:1952356081
Name:DEL RIO, DAWN LOUISE (PHD)
Entity type:Individual
Prefix:DR
First Name:DAWN
Middle Name:LOUISE
Last Name:DEL RIO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:DAWN
Other - Middle Name:LOUISE
Other - Last Name:DEL RIO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:2680 GALIOT COURT LANSING
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911
Mailing Address - Country:US
Mailing Address - Phone:517-755-8068
Mailing Address - Fax:517-210-3486
Practice Address - Street 1:1200 N WEST AVE
Practice Address - Street 2:SUITE 809
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202
Practice Address - Country:US
Practice Address - Phone:517-300-7570
Practice Address - Fax:517-210-3486
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
MI6801079615104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI8008971240OtherTRADITIONAL BCBS
MI515264OtherVALUE OPTIONS
MI8008971240OtherTRADITIONAL BCBS
MIP54680003Medicare PIN