Provider Demographics
NPI:1801827241
Name:DRYDEN, MARY C (LPC, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:C
Last Name:DRYDEN
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 TWIN LAKE XING
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-0701
Mailing Address - Country:US
Mailing Address - Phone:601-584-9540
Mailing Address - Fax:601-584-9510
Practice Address - Street 1:1003 W PINE ST
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-5049
Practice Address - Country:US
Practice Address - Phone:601-584-9540
Practice Address - Fax:601-584-9510
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS0555101YP2500X
MST0373106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist