Provider Demographics
NPI:1285133611
Name:DAWKINS-CLARKE, PAULETTE (LPC)
Entity type:Individual
Prefix:
First Name:PAULETTE
Middle Name:
Last Name:DAWKINS-CLARKE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 AUSTELL RD SW APT 421
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30008-2117
Mailing Address - Country:US
Mailing Address - Phone:770-693-2864
Mailing Address - Fax:
Practice Address - Street 1:2140 MCGEE RD
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-2980
Practice Address - Country:US
Practice Address - Phone:678-630-7564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-12
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC008538101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health