Provider Demographics
NPI:1114456175
Name:DICKENS, EBONYE JUNAE (RMHCI)
Entity Type:Individual
Prefix:
First Name:EBONYE
Middle Name:JUNAE
Last Name:DICKENS
Suffix:
Gender:F
Credentials:RMHCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 COLLEGE PKWY UNIT 575
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32563-2711
Mailing Address - Country:US
Mailing Address - Phone:850-861-7171
Mailing Address - Fax:
Practice Address - Street 1:8418 E BAY BLVD
Practice Address - Street 2:
Practice Address - City:NAVARRE
Practice Address - State:FL
Practice Address - Zip Code:32566-6306
Practice Address - Country:US
Practice Address - Phone:850-463-5191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-05
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH14452101YM0800X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional