Provider Demographics
NPI:1841335270
Name:DEAN, MARY JAMES (DMIN, MA, LMFT, C)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:JAMES
Last Name:DEAN
Suffix:
Gender:F
Credentials:DMIN, MA, LMFT, C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 HAMPTON WAY
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30116
Mailing Address - Country:US
Mailing Address - Phone:678-438-7058
Mailing Address - Fax:678-664-2173
Practice Address - Street 1:140 HAMPTON WAY
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30116
Practice Address - Country:US
Practice Address - Phone:678-438-7058
Practice Address - Fax:678-664-2173
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT000985106H00000X
GACERTIFICATION #1767R101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA246920824AMedicaid