Provider Demographics
NPI:1538174479
Name:DYSON, JULIE ELISE (LPC)
Entity type:Individual
Prefix:MISS
First Name:JULIE
Middle Name:ELISE
Last Name:DYSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 VILLAGE LN
Mailing Address - Street 2:APT. 1404
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-4622
Mailing Address - Country:US
Mailing Address - Phone:860-637-6592
Mailing Address - Fax:
Practice Address - Street 1:26 RUSSELL ST
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06052-1313
Practice Address - Country:US
Practice Address - Phone:860-223-2778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001494101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor