Healthcare Provider Details

I. General information

NPI: 1588844393
Provider Name (Legal Business Name): SHUNTAE DAWSON M.F.T
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JOY DAWSON M.F.T

II. Dates (important events)

Enumeration Date: 11/08/2007
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 DARCY PKWY
LATHROP CA
95330-9219
US

IV. Provider business mailing address

107 DARCY PKWY
LATHROP CA
95330-9219
US

V. Phone/Fax

Practice location:
  • Phone: 209-808-6892
  • Fax:
Mailing address:
  • Phone: 209-808-6892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number51414
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number51414
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number51414
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number51414
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number51414
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: