Healthcare Provider Details

I. General information

NPI: 1053818716
Provider Name (Legal Business Name): JANELLE DAWSEY LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2018
Last Update Date: 04/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 CAMPBELL HILL ST NW
MARIETTA GA
30060-1134
US

IV. Provider business mailing address

250 CORPORATE CENTER CT
STOCKBRIDGE GA
30281-6388
US

V. Phone/Fax

Practice location:
  • Phone: 470-795-7695
  • Fax:
Mailing address:
  • Phone: 770-389-8100
  • Fax: 678-782-6622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number001614
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: