Healthcare Provider Details

I. General information

NPI: 1467593723
Provider Name (Legal Business Name): DAWN M MORT MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DAWN MANCE LMHC, LCAC

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 07/23/2021
Certification Date: 07/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10489 HELEY ST
SPRING HILL FL
34608-3729
US

IV. Provider business mailing address

9176 GENEVA ST
SPRING HILL FL
34608-6207
US

V. Phone/Fax

Practice location:
  • Phone: 352-422-3711
  • Fax: 352-623-5463
Mailing address:
  • Phone: 352-422-3711
  • Fax: 352-623-5463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number87000117A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH16045
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39002221A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: