Provider Demographics
NPI:1164753414
Name:JARVIS, DENNIS JUSTIN (THD, LMFT)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:JUSTIN
Last Name:JARVIS
Suffix:
Gender:M
Credentials:THD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 S THORNTON AVE
Mailing Address - Street 2:P.O. BOX 1852
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-8287
Mailing Address - Country:US
Mailing Address - Phone:706-280-7530
Mailing Address - Fax:706-278-3979
Practice Address - Street 1:623 S THORNTON AVE
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-8287
Practice Address - Country:US
Practice Address - Phone:706-280-7530
Practice Address - Fax:706-278-3979
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-27
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001012106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist