Provider Demographics
NPI:1497896856
Name:BYRD, DABNEY L (LMHC)
Entity Type:Individual
Prefix:
First Name:DABNEY
Middle Name:L
Last Name:BYRD
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 CENTRE ST
Mailing Address - Street 2:MAXWELL BUILDING, SUITE 114
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-3936
Mailing Address - Country:US
Mailing Address - Phone:904-491-8003
Mailing Address - Fax:904-491-8003
Practice Address - Street 1:501 CENTRE ST
Practice Address - Street 2:MAXWELL BUILDING, SUITE 114
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-3936
Practice Address - Country:US
Practice Address - Phone:904-225-8280
Practice Address - Fax:904-491-8003
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9395101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL769044400Medicaid