Provider Demographics
NPI:1306679352
Name:DUBOSE, EMMA (MA, MFT-I)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:DUBOSE
Suffix:
Gender:F
Credentials:MA, MFT-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 HANOVER ST
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37405-3020
Mailing Address - Country:US
Mailing Address - Phone:423-619-6085
Mailing Address - Fax:
Practice Address - Street 1:1222 TREMONT ST STE 100A
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37405-3038
Practice Address - Country:US
Practice Address - Phone:423-619-6085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-24
Last Update Date:2024-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2321106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist