Basic Information
Provider Information
NPI: 1598153363
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: JONES-WILSON
FirstName: DAWN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: LPCC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 614
Address2:  
City: HOPKINSVILLE
State: KY
PostalCode: 422410614
CountryCode: US
TelephoneNumber: 2708862205
FaxNumber:  
Practice Location
Address1: 607 HAMMOND PLZ
Address2:  
City: HOPKINSVILLE
State: KY
PostalCode: 422404971
CountryCode: US
TelephoneNumber: 2708860486
FaxNumber:  
Other Information
ProviderEnumerationDate: 01/02/2015
LastUpdateDate: 08/29/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YP2500X173232KYY Behavioral Health & Social Service ProvidersCounselorProfessional

No ID Information.


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