Provider Demographics
NPI:1558629147
Name:DENNIS, JAMELLE DIONNE
Entity Type:Individual
Prefix:MRS
First Name:JAMELLE
Middle Name:DIONNE
Last Name:DENNIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 68TH AVE S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-5952
Mailing Address - Country:US
Mailing Address - Phone:727-543-0268
Mailing Address - Fax:727-896-1426
Practice Address - Street 1:3840 5TH AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713
Practice Address - Country:US
Practice Address - Phone:727-367-2273
Practice Address - Fax:727-800-6929
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-02
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH11795101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health