MEDICARE: LISA S. DOLGIN MSE, NCC, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor
2	101YP2500X	Professional Counselor	4231-125	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679777361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA S. DOLGIN MSE, NCC, LPC

Provider Business Mailing Address
First Line	:	2405 NORTHWESTERN AVE
Second Line	:
City	:	RACINE
State	:	WI
Zip	:	53404-2534
Country	:	US
Telephone Number	:	262-886-0474
Fax Number	:	262-898-3378

Provider Business Practice Location Address
First Line	:	2405 NORTHWESTERN AVE
Second Line	:
City	:	RACINE
State	:	WI
Zip	:	53404-2534
Country	:	US
Telephone Number	:	262-886-0474
Fax Number	:	262-898-3378

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2007
Last Update Date	:	04/15/2013

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