Healthcare Provider Details

I. General information

NPI: 1730246620
Provider Name (Legal Business Name): DAWN S O'MALLEY PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 REYNOLDA RD
WINSTON SALEM NC
27104-3245
US

IV. Provider business mailing address

5821 FAIRVIEW RD SUITE 218
CHARLOTTE NC
28209-5601
US

V. Phone/Fax

Practice location:
  • Phone: 336-721-7600
  • Fax: 336-728-4355
Mailing address:
  • Phone: 704-554-0443
  • Fax: 704-643-5965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2244
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: