Provider Demographics
NPI:1548991375
Name:NEWELL, DWIGHT WILSON (LPC-S)
Entity type:Individual
Prefix:
First Name:DWIGHT
Middle Name:WILSON
Last Name:NEWELL
Suffix:
Gender:M
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15465 OAK LN STE 100I
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-2663
Mailing Address - Country:US
Mailing Address - Phone:855-939-6634
Mailing Address - Fax:
Practice Address - Street 1:2911 A W GRIMES BLVD STE 330
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-1979
Practice Address - Country:US
Practice Address - Phone:512-883-7112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-22
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS813101YP2500X
TX91168101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional