Provider Demographics
NPI:1891925335
Name:BEAIRD, DOLAN SAMUEL
Entity type:Individual
Prefix:MR
First Name:DOLAN
Middle Name:SAMUEL
Last Name:BEAIRD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2037 WILLOW DR
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-3842
Mailing Address - Country:US
Mailing Address - Phone:707-291-2208
Mailing Address - Fax:707-778-1334
Practice Address - Street 1:2037 WILLOW DR
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-3842
Practice Address - Country:US
Practice Address - Phone:707-291-2208
Practice Address - Fax:707-778-1334
Is Sole Proprietor?:No
Enumeration Date:2009-07-17
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor