Provider Demographics
NPI:1063522175
Name:WELCH, DAWN WEBB (MSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:WEBB
Last Name:WELCH
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:MS
Other - First Name:DAWN
Other - Middle Name:LASHEA
Other - Last Name:WEBB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:PO BOX 245
Mailing Address - Street 2:
Mailing Address - City:HALIFAX
Mailing Address - State:NC
Mailing Address - Zip Code:27839-0245
Mailing Address - Country:US
Mailing Address - Phone:252-532-0057
Mailing Address - Fax:
Practice Address - Street 1:230 SAINT DAVID STREET
Practice Address - Street 2:
Practice Address - City:HALIFAX
Practice Address - State:NC
Practice Address - Zip Code:27839
Practice Address - Country:US
Practice Address - Phone:252-532-0057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040070261041C0700X
NCC0048371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC143A3OtherBLUECROSSBLUESHIELD
NC6003148Medicaid