Healthcare Provider Details

I. General information

NPI: 1881567295
Provider Name (Legal Business Name): TY'ASIA DAWSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2025
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 JESSE JEWELL PKWY SE
GAINESVILLE GA
30501-3779
US

IV. Provider business mailing address

5010 W BROAD ST APT 3204
SUGAR HILL GA
30518-4217
US

V. Phone/Fax

Practice location:
  • Phone: 770-287-0290
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPC010487
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: