Provider Demographics
NPI:1053578070
Name:DAWSON, PENELOPE (LPC)
Entity type:Individual
Prefix:
First Name:PENELOPE
Middle Name:
Last Name:DAWSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 HICKOTY ST
Mailing Address - Street 2:STE 404
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-2522
Mailing Address - Country:US
Mailing Address - Phone:706-270-5033
Mailing Address - Fax:
Practice Address - Street 1:900 SHUGART RD
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-2467
Practice Address - Country:US
Practice Address - Phone:706-270-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005224101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GALPC005224OtherLICENSE