Provider Demographics
NPI:1558381327
Name:DUBBERT, PATRICIA MARIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:MARIE
Last Name:DUBBERT
Suffix:
Gender:F
Credentials:PHD
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Mailing Address - Street 1:1500 E WOODROW WILSON AVE
Mailing Address - Street 2:VA MEDICAL CENTER MENTAL HEALTH 11M
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-5116
Mailing Address - Country:US
Mailing Address - Phone:601-362-4471
Mailing Address - Fax:601-364-1395
Practice Address - Street 1:1500 E WOODROW WILSON AVE
Practice Address - Street 2:VA MEDICAL CENTER MENTAL HEALTH 11M
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-5116
Practice Address - Country:US
Practice Address - Phone:601-362-4471
Practice Address - Fax:601-364-1395
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS24310103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical