Doctor Name: | PHYLLIS DUNHAM |
NPI Number: | 1326281783 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 349 Colesburg-tompkin Rd. Woodbine, GA - 31569 |
Business Phone Number: | 9045536187 |
Business Fax Number: | 9125765052 |
Mailing Address: | P O Box 522, WOODBINE |
State: | GA |
Postal Code: | 31569 |
Phone Number: | 9045536187 |
Fax Number: | 9125765052 |
NPI Enumeration Date: | 04/15/2009 |
NPI Last Update Date: | 03/27/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |