Provider Demographics
NPI:1588722094
Name:NELSON, DAWN WALDRON (LCSW, ACSW, CART)
Entity type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:WALDRON
Last Name:NELSON
Suffix:
Gender:F
Credentials:LCSW, ACSW, CART
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 LAKEWAY DR
Mailing Address - Street 2:
Mailing Address - City:HEATH
Mailing Address - State:TX
Mailing Address - Zip Code:75032-7609
Mailing Address - Country:US
Mailing Address - Phone:972-989-2799
Mailing Address - Fax:
Practice Address - Street 1:22 LAKEWAY DR
Practice Address - Street 2:
Practice Address - City:HEATH
Practice Address - State:TX
Practice Address - Zip Code:75032-7609
Practice Address - Country:US
Practice Address - Phone:972-989-2799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXLCSW 177851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXSW00S53Z0Medicaid
TX00S53ZMedicare ID - Type Unspecified