Healthcare Provider Details

I. General information

NPI: 1942930433
Provider Name (Legal Business Name): DAWN RENEE EADS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2022
Last Update Date: 06/16/2022
Certification Date: 06/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5768 S SEMORAN BLVD
ORLANDO FL
32822-4818
US

IV. Provider business mailing address

3185 REYNOLDS RD
BARTOW FL
33830-9294
US

V. Phone/Fax

Practice location:
  • Phone: 407-896-2323
  • Fax:
Mailing address:
  • Phone: 941-465-0885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: