Individual
JAYNE M DUBOIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
6110 SHALLOWFORD RD, C/O CRC, CHATTANOOGA, TN 37421-1894
(800) 632-6074
Mailing address
7431 114TH AVE, SUITE 104, LARGO, FL 33773-5119
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
P0000001925
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1508707
—
TN
Enumeration date
10/08/2008
Last updated
02/18/2009
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