Provider Demographics
NPI:1154956837
Name:DAWSON, BOBBIE J
Entity type:Individual
Prefix:MS
First Name:BOBBIE
Middle Name:J
Last Name:DAWSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 BARRS LN
Mailing Address - Street 2:C/O DAWSON
Mailing Address - City:SALEM
Mailing Address - State:WV
Mailing Address - Zip Code:26426-6224
Mailing Address - Country:US
Mailing Address - Phone:304-362-5610
Mailing Address - Fax:
Practice Address - Street 1:215 BARRS LN
Practice Address - Street 2:C/O DAWSON
Practice Address - City:SALEM
Practice Address - State:WV
Practice Address - Zip Code:26426-6224
Practice Address - Country:US
Practice Address - Phone:304-362-5610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-03
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X, 261QR1300X
WV101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)