Provider Demographics
NPI:1952769945
Name:DILWORTH, JACINDA DAWN (MA, CMHT)
Entity Type:Individual
Prefix:MRS
First Name:JACINDA
Middle Name:DAWN
Last Name:DILWORTH
Suffix:
Gender:F
Credentials:MA, CMHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1290
Mailing Address - Street 2:
Mailing Address - City:IUKA
Mailing Address - State:MS
Mailing Address - Zip Code:38852-6290
Mailing Address - Country:US
Mailing Address - Phone:662-423-3332
Mailing Address - Fax:662-423-3331
Practice Address - Street 1:1213 MARIA LN
Practice Address - Street 2:
Practice Address - City:IUKA
Practice Address - State:MS
Practice Address - Zip Code:38852-1135
Practice Address - Country:US
Practice Address - Phone:662-423-3332
Practice Address - Fax:662-423-3331
Is Sole Proprietor?:No
Enumeration Date:2016-02-04
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MS101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health