Provider Demographics
NPI:1588757280
Name:DOLHAM, DONNA HELEN (LCSW)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:HELEN
Last Name:DOLHAM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1866 CLARRY HILL ROAD
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:ME
Mailing Address - Zip Code:04862
Mailing Address - Country:US
Mailing Address - Phone:207-273-2171
Mailing Address - Fax:207-273-2554
Practice Address - Street 1:1866 CLARRY HILL ROAD
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:ME
Practice Address - Zip Code:04862
Practice Address - Country:US
Practice Address - Phone:207-273-2171
Practice Address - Fax:207-273-2554
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC3702101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEDOMM8099Medicare ID - Type UnspecifiedMEDICARE #