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General NPI Number Information
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NPI Number | 1306018635
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Entity Type | Individual
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Provider Name | DAMON WESLEY DYE L.M.H.C., N.C.G.C.II
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Gender | Male
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Dates
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Enumeration Date | 03/26/2008
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Last Update Date | 04/22/2016
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Provider Practice Location Address
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Address Line | 6322 US HIGHWAY 301 S
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City | RIVERVIEW
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State | FL
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Zip | 33578-3829
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Country | US
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Telephone | 813-413-7575
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Fax | 813-217-8174
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Provider Business Mailing Address
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Address Line | 6322 US HIGHWAY 301 S
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City | RIVERVIEW
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State | FL
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Zip | 33578-3829
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Country | US
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Telephone | 813-413-7575
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Fax | 813-217-8174
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH 9382
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License Number State | FL
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