Provider Demographics
NPI:1992934962
Name:MCDANIEL, DAWN DELFIN (PHD)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:DELFIN
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 MCLENDON AVE NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30307-2046
Mailing Address - Country:US
Mailing Address - Phone:678-466-0801
Mailing Address - Fax:
Practice Address - Street 1:900 DEKALB AVE NE STE K
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30307-2501
Practice Address - Country:US
Practice Address - Phone:678-466-0801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-10
Last Update Date:2024-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPS-T001146103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical