Healthcare Provider Details

I. General information

NPI: 1801056221
Provider Name (Legal Business Name): RACHAEL ANN DYSON M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2008
Last Update Date: 04/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 DOUGLAS AVE SUITE 200
ALTAMONTE SPRINGS FL
32714-5206
US

IV. Provider business mailing address

315 N LAKEMONT AVE SUITE B
WINTER PARK FL
32792-3205
US

V. Phone/Fax

Practice location:
  • Phone: 407-830-6412
  • Fax: 407-830-8413
Mailing address:
  • Phone: 407-830-6412
  • Fax: 407-830-8413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6186
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: