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General NPI Number Information
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NPI Number | 1720608540
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Entity Type | Organization
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Legal Business Name | GREATER DALLAS SUPPORT ALLIANCE
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Dates
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Enumeration Date | 04/22/2020
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Last Update Date | 09/30/2020
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Provider Practice Location Address
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Address Line | 2102 DORSEY DR
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City | FORNEY
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State | TX
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Zip | 75126-0925
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Country | US
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Telephone | 469-249-3585
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Fax | 469-249-3585
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Provider Business Mailing Address
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Address Line | PO BOX 1350
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City | FORNEY
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State | TX
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Zip | 75126-1350
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Country | US
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Telephone | 972-521-6105
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JENNIFER LEE BOATRIGHT
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Credential | LPC
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Telephone | 469-249-2585
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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