Healthcare Provider Details

I. General information

NPI: 1487202594
Provider Name (Legal Business Name): JOSEPH C DYSON SR. PH.D., NCC, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2019
Last Update Date: 09/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 GOVERNOR NICHOLLS ST
NEW ORLEANS LA
70116-2323
US

IV. Provider business mailing address

1325 GOV. NICHOLLS STREET
NEW ORLEANS LA
70116
US

V. Phone/Fax

Practice location:
  • Phone: 504-427-6999
  • Fax: 504-525-0857
Mailing address:
  • Phone: 504-427-6999
  • Fax: 504-525-0857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6141
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: