Healthcare Provider Details

I. General information

NPI: 1700552783
Provider Name (Legal Business Name): MICHELLE-DAWNE HUSTON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2021
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 CLAY ST
MARTINSVILLE VA
24112-2810
US

IV. Provider business mailing address

1621 CANDLEWOOD DR
UPLAND CA
91784-9176
US

V. Phone/Fax

Practice location:
  • Phone: 276-632-7128
  • Fax:
Mailing address:
  • Phone: 404-384-0564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW007561
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904014261
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: