Provider Demographics
NPI:1023509411
Name:DAWSON, T. L (QMHS)
Entity type:Individual
Prefix:MS
First Name:T.
Middle Name:L
Last Name:DAWSON
Suffix:
Gender:F
Credentials:QMHS
Other - Prefix:MS
Other - First Name:TRACEY
Other - Middle Name:L
Other - Last Name:DAWSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:REV
Mailing Address - Street 1:209 W WOODLAND AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44502-1866
Mailing Address - Country:US
Mailing Address - Phone:330-787-9180
Mailing Address - Fax:
Practice Address - Street 1:209 W WOODLAND AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44502-1866
Practice Address - Country:US
Practice Address - Phone:330-787-9180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-22
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker