Provider Demographics
NPI:1801056221
Name:DYSON, RACHAEL ANN (MA)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:ANN
Last Name:DYSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:315 N LAKEMONT AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-3205
Mailing Address - Country:US
Mailing Address - Phone:407-830-6412
Mailing Address - Fax:407-830-8413
Practice Address - Street 1:801 DOUGLAS AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-5206
Practice Address - Country:US
Practice Address - Phone:407-830-6412
Practice Address - Fax:407-830-8413
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL6186101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional