Provider Demographics
NPI:1710416888
Name:DOBESOVA, JANA (LPC-MHSP)
Entity Type:Individual
Prefix:
First Name:JANA
Middle Name:
Last Name:DOBESOVA
Suffix:
Gender:F
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2971 FORT HENRY DR
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37664-4005
Mailing Address - Country:US
Mailing Address - Phone:423-392-2975
Mailing Address - Fax:423-390-1686
Practice Address - Street 1:2971 FORT HENRY DR
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37664-4005
Practice Address - Country:US
Practice Address - Phone:423-392-2975
Practice Address - Fax:423-390-1686
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3950101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional