Individual
DR. DYNESHA DIONE MASON-GRISSOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
2500 GALEN DR STE 104, CHAMPAIGN, IL 61821-7038
(217) 693-6072
Mailing address
2500 GALEN DR STE 104, CHAMPAIGN, IL 61821-7038
(217) 693-6072
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
103TC1900X
Counseling Psychologist
—
—
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
103TF0000X
Family Psychologist
—
—
Other
Enumeration date
11/13/2018
Last updated
01/21/2020
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