Provider Demographics
NPI:1699113084
Name:DAWSON, DANIELLE LEA (LMFT 81526)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:LEA
Last Name:DAWSON
Suffix:
Gender:F
Credentials:LMFT 81526
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22362 GILBERTO STE 130
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-2142
Mailing Address - Country:US
Mailing Address - Phone:714-905-9715
Mailing Address - Fax:949-335-6617
Practice Address - Street 1:22362 GILBERTO STE 130
Practice Address - Street 2:
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-2142
Practice Address - Country:US
Practice Address - Phone:714-905-9715
Practice Address - Fax:949-335-6617
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-07
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF68571106H00000X
CAMFC 81529106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist