Provider Demographics
NPI:1831294313
Name:FAULKNER, DESSIE ELIZABETH (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:DESSIE
Middle Name:ELIZABETH
Last Name:FAULKNER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12231 ASHLEY DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-2775
Mailing Address - Country:US
Mailing Address - Phone:228-831-9400
Mailing Address - Fax:228-831-9600
Practice Address - Street 1:12231 ASHLEY DR
Practice Address - Street 2:SUITE C
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-2775
Practice Address - Country:US
Practice Address - Phone:228-831-9400
Practice Address - Fax:228-831-9600
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST0329106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist