=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003588187
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | A NEW DAWN, A NEW BEGINNING, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/28/2021
-----------------------------------------------------
Last Update Date | 09/28/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 117 SW VIRGINIA CIR
-----------------------------------------------------
City | MAYO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32066-4065
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-329-5776
-----------------------------------------------------
Fax | 888-974-6195
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1726
-----------------------------------------------------
City | PERRY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32348-7305
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-295-3878
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DAWNA M HASWELL
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 850-329-5776
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------