Provider Demographics
NPI:1386996247
Name:DOLAN, ALIAH (MS, MFT INTERN)
Entity type:Individual
Prefix:
First Name:ALIAH
Middle Name:
Last Name:DOLAN
Suffix:
Gender:F
Credentials:MS, MFT INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4250 SW HUME ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-3553
Mailing Address - Country:US
Mailing Address - Phone:415-867-1001
Mailing Address - Fax:
Practice Address - Street 1:4250 SW HUME ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-3553
Practice Address - Country:US
Practice Address - Phone:415-867-1001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-02
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA91053101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health