Healthcare Provider Details

I. General information

NPI: 1811102858
Provider Name (Legal Business Name): ANDREA D. DAWKINS MA CAP ICADC NCACIP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DAWN DAWKINS MA CAP ICADC NCACIP

II. Dates (important events)

Enumeration Date: 05/12/2007
Last Update Date: 03/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2640 HIAWATHA AVE SUITE E
SANFORD FL
32773-5342
US

IV. Provider business mailing address

2294 NEWMARK DR
DELTONA FL
32738-6214
US

V. Phone/Fax

Practice location:
  • Phone: 407-603-3579
  • Fax: 407-495-5709
Mailing address:
  • Phone: 407-603-3579
  • Fax: 407-495-5709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4270
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number4270
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number4270
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number StateOK
# 5
Primary TaxonomyN
Taxonomy Code174V00000X
TaxonomyClinical Ethicist
License Number
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number120578
License Number StateFL
# 7
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: