Healthcare Provider Details

I. General information

NPI: 1770786790
Provider Name (Legal Business Name): PATRICIA UMLAUF DAWSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 11/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23668 FRONT STREET
ACCOMAC VA
23301
US

IV. Provider business mailing address

PO BOX 7050
RICHMOND VA
23221-0050
US

V. Phone/Fax

Practice location:
  • Phone: 757-787-3080
  • Fax:
Mailing address:
  • Phone: 804-514-8696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number0904002619
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: