Provider Demographics
NPI:1124769260
Name:VAN BERKEL, DAWN (RIC)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:VAN BERKEL
Suffix:
Gender:F
Credentials:RIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 N KING ST STE 210
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-2846
Mailing Address - Country:US
Mailing Address - Phone:571-302-4515
Mailing Address - Fax:
Practice Address - Street 1:26 N KING ST STE 210
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-2846
Practice Address - Country:US
Practice Address - Phone:571-302-4515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704014516101YP2500X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional