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General NPI Number Information
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NPI Number | 1396376257
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Entity Type | Individual
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Provider Name | JIMMY GLENN DOOLITTLE
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Gender | Male
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Dates
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Enumeration Date | 01/30/2020
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Last Update Date | 03/07/2022
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Provider Practice Location Address
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Address Line | 990 MIGEON AVE
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City | TORRINGTON
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State | CT
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Zip | 06790-4555
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Country | US
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Telephone | 203-525-1233
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Fax |
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Provider Business Mailing Address
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Address Line | 4319 W RAILROAD ST
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City | GULFPORT
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State | MS
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Zip | 39501-1407
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Country | US
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Telephone | 228-239-4249
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 1622
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 005290
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License Number State | CT
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