Provider Demographics
NPI:1730246620
Name:O'MALLEY, DAWN S (PSYD)
Entity type:Individual
Prefix:DR
First Name:DAWN
Middle Name:S
Last Name:O'MALLEY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5821 FAIRVIEW RD
Mailing Address - Street 2:SUITE 218
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-5601
Mailing Address - Country:US
Mailing Address - Phone:704-554-0443
Mailing Address - Fax:704-643-5965
Practice Address - Street 1:5821 FAIRVIEW RD
Practice Address - Street 2:SUITE 218
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-5601
Practice Address - Country:US
Practice Address - Phone:704-554-0443
Practice Address - Fax:704-643-5965
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2244103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000064Medicaid
NC6000064Medicaid