Provider Demographics
NPI:1952812752
Name:DAWN, HEIDI (PSYD)
Entity Type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:
Last Name:DAWN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7821 SAINT ANDREWS RD UNIT 2512
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-4134
Mailing Address - Country:US
Mailing Address - Phone:803-250-5109
Mailing Address - Fax:803-369-6109
Practice Address - Street 1:1331 ELMWOOD AVE STE 300B
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2150
Practice Address - Country:US
Practice Address - Phone:803-200-2601
Practice Address - Fax:803-961-6600
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-19
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5430103TC0700X
CA17115103TC0700X, 103T00000X
SC1528103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical