MEDICARE: DINNAN THERAPIES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1801590724
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DINNAN THERAPIES LLC

Provider Business Mailing Address
First Line	:	2843 SAINT AUGUSTINE DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32825-7139
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2843 SAINT AUGUSTINE DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32825-7139
Country	:	US
Telephone Number	:	803-814-3404
Fax Number	:

Authorized Official
Title or Position	:	COUNSELOR
Name	:	JOSSELYN DINNAN
Credential	:	LMHC
Telephone Number	:	703-975-1675

Provider Enumeration Date	:	03/27/2023
Last Update Date	:	03/27/2023

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