Provider Demographics
NPI:1780341180
Name:HARBISON, DAWNMARIE (LAC)
Entity type:Individual
Prefix:
First Name:DAWNMARIE
Middle Name:
Last Name:HARBISON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42201 N 41ST DR STE 160
Mailing Address - Street 2:
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-3803
Mailing Address - Country:US
Mailing Address - Phone:480-527-0042
Mailing Address - Fax:480-499-5921
Practice Address - Street 1:42201 N 41ST DR STE 160
Practice Address - Street 2:
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086-3803
Practice Address - Country:US
Practice Address - Phone:480-527-0042
Practice Address - Fax:480-499-5921
Is Sole Proprietor?:No
Enumeration Date:2021-11-19
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-18465101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health