=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255974135
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEPHANIE MARIE DAWKINS LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/23/2019
-----------------------------------------------------
Last Update Date | 10/23/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15521 MIDLOTHIAN TPKE STE 105
-----------------------------------------------------
City | MIDLOTHIAN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23113-7313
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-423-1550
-----------------------------------------------------
Fax | 804-464-2376
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9202 CENTER OAK CT
-----------------------------------------------------
City | MECHANICSVILLE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23116-2744
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-730-0432
-----------------------------------------------------
Fax | 804-730-2829
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 0904011301
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------