Provider Demographics
NPI:1114456175
Name:DICKENS, EBONYE JUNAE (LMHC)
Entity type:Individual
Prefix:
First Name:EBONYE
Middle Name:JUNAE
Last Name:DICKENS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 COLLEGE PKWY UNIT 675
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32563-2711
Mailing Address - Country:US
Mailing Address - Phone:850-966-3030
Mailing Address - Fax:
Practice Address - Street 1:217 MIRACLE STRIP PKWY SE STE 121
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548-5819
Practice Address - Country:US
Practice Address - Phone:850-966-3030
Practice Address - Fax:850-563-9100
Is Sole Proprietor?:No
Enumeration Date:2017-06-05
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
FLIMH14452101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional