Provider Demographics
NPI:1235593963
Name:E ANNE DUBOIS M ED, PA
Entity Type:Organization
Organization Name:E ANNE DUBOIS M ED, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:E
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:DUBOIS
Authorized Official - Suffix:
Authorized Official - Credentials:M ED, LMHC
Authorized Official - Phone:321-777-8930
Mailing Address - Street 1:2194 HIGHWAY A1A
Mailing Address - Street 2:SUITE 203
Mailing Address - City:INDIAN HARBOUR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-4930
Mailing Address - Country:US
Mailing Address - Phone:321-777-8930
Mailing Address - Fax:321-773-5479
Practice Address - Street 1:2194 HIGHWAY A1A
Practice Address - Street 2:SUITE 203
Practice Address - City:INDIAN HARBOUR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-4930
Practice Address - Country:US
Practice Address - Phone:321-777-8930
Practice Address - Fax:321-773-5479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-08
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1551101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty