Provider Demographics
NPI:1871058594
Name:DYER, CARLENE JENAE
Entity type:Individual
Prefix:MS
First Name:CARLENE
Middle Name:JENAE
Last Name:DYER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 W SACRAMENTO AVE UNIT 109
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-4238
Mailing Address - Country:US
Mailing Address - Phone:707-761-1704
Mailing Address - Fax:
Practice Address - Street 1:200 E SPRUCE ST
Practice Address - Street 2:
Practice Address - City:GRIDLEY
Practice Address - State:CA
Practice Address - Zip Code:95948-2263
Practice Address - Country:US
Practice Address - Phone:530-846-7305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-06
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty