Provider Demographics
NPI:1831450477
Name:MASON, DINAH LYNN (MFTI)
Entity type:Individual
Prefix:MS
First Name:DINAH
Middle Name:LYNN
Last Name:MASON
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3545 SAINT JOHNS BLUFF RD S
Mailing Address - Street 2:SUITE 156
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-2682
Mailing Address - Country:US
Mailing Address - Phone:904-635-5031
Mailing Address - Fax:904-724-4509
Practice Address - Street 1:10175 FORTUNE PKWY
Practice Address - Street 2:SUITE 1102
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-6746
Practice Address - Country:US
Practice Address - Phone:904-635-5031
Practice Address - Fax:904-724-4509
Is Sole Proprietor?:No
Enumeration Date:2012-05-30
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMT 1730106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist