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General NPI Number Information
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NPI Number | 1396389235
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Entity Type | Individual
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Provider Name | AUTUMN KATHLEEN DOLAN LMFT
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Gender | Female
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Dates
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Enumeration Date | 11/04/2019
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Last Update Date | 11/04/2019
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Provider Practice Location Address
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Address Line | 11011 SHERIDAN ST STE 211
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City | HOLLYWOOD
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State | FL
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Zip | 33026-1531
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Country | US
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Telephone | 954-951-2929
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Fax |
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Provider Business Mailing Address
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Address Line | 5240 N HILLS DR
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City | HOLLYWOOD
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State | FL
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Zip | 33021-1623
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Country | US
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Telephone | 754-264-6255
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MT3448
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License Number State |
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