Healthcare Provider Details

I. General information

NPI: 1689997298
Provider Name (Legal Business Name): VICTORIA LEE DAWSON LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2010
Last Update Date: 08/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10810 HAMBURG RD
HAMBURG MI
48139-1215
US

IV. Provider business mailing address

PO BOX 183
HAMBURG MI
48139-0183
US

V. Phone/Fax

Practice location:
  • Phone: 810-231-9226
  • Fax: 810-231-2425
Mailing address:
  • Phone: 810-231-9226
  • Fax: 810-231-2425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801061580
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: