Provider Demographics
NPI:1821827643
Name:DUNN, MATTIE JANE (LPC)
Entity type:Individual
Prefix:
First Name:MATTIE
Middle Name:JANE
Last Name:DUNN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 E SECOND ST
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-2949
Mailing Address - Country:US
Mailing Address - Phone:610-605-1906
Mailing Address - Fax:
Practice Address - Street 1:24 E SECOND ST
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-2949
Practice Address - Country:US
Practice Address - Phone:610-605-1906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC017379101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty