Provider Demographics
NPI:1760698294
Name:CAIN, DENNIS NELSON (LAMFT)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:NELSON
Last Name:CAIN
Suffix:
Gender:M
Credentials:LAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 FOUNTAINHEAD DR
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:GA
Mailing Address - Zip Code:30549-6711
Mailing Address - Country:US
Mailing Address - Phone:706-367-5448
Mailing Address - Fax:
Practice Address - Street 1:455 N LUMPKIN ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30601-2744
Practice Address - Country:US
Practice Address - Phone:706-369-7911
Practice Address - Fax:706-208-9509
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000108106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1290OtherMHP MENTAL HEALTH PRO