Provider Demographics
NPI:1427467844
Name:DEFALCO, DAWN (LPC)
Entity type:Individual
Prefix:MS
First Name:DAWN
Middle Name:
Last Name:DEFALCO
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 1:3454 OAK ALLEY CT
Mailing Address - Street 2:SUITE #305
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-1306
Mailing Address - Country:US
Mailing Address - Phone:419-534-2468
Mailing Address - Fax:419-534-2397
Practice Address - Street 1:3454 OAK ALLEY CT
Practice Address - Street 2:SUITE #305
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-1306
Practice Address - Country:US
Practice Address - Phone:419-534-2468
Practice Address - Fax:419-534-2397
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-11
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.0500711101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional