Provider Demographics
NPI:1942964457
Name:DEAN, CHARLES III (LMHC)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:
Last Name:DEAN
Suffix:III
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12400 YELLOW BLUFF RD STE 107
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32226-5070
Mailing Address - Country:US
Mailing Address - Phone:904-254-8421
Mailing Address - Fax:
Practice Address - Street 1:12400 YELLOW BLUFF RD STE 107
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32226-5070
Practice Address - Country:US
Practice Address - Phone:904-254-8421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-30
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11471101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health