Healthcare Provider Details

I. General information

NPI: 1194486050
Provider Name (Legal Business Name): ZACHARY KEVIN DAWKINS LISW-CP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2022
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 POWDERHORN RD
SIMPSONVILLE SC
29681-3375
US

IV. Provider business mailing address

807 POWDERHORN RD
SIMPSONVILLE SC
29681-3375
US

V. Phone/Fax

Practice location:
  • Phone: 217-649-6457
  • Fax:
Mailing address:
  • Phone: 217-649-6457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number18910
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: