Provider Demographics
NPI:1114268455
Name:FORD, DOLORES (MS, NCC, LMHCA)
Entity Type:Individual
Prefix:MS
First Name:DOLORES
Middle Name:
Last Name:FORD
Suffix:
Gender:F
Credentials:MS, NCC, LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1484
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:WA
Mailing Address - Zip Code:98823-1484
Mailing Address - Country:US
Mailing Address - Phone:509-237-9753
Mailing Address - Fax:
Practice Address - Street 1:55 ALDER ST NW
Practice Address - Street 2:SUITE 204
Practice Address - City:EPHRATA
Practice Address - State:WA
Practice Address - Zip Code:98823-1696
Practice Address - Country:US
Practice Address - Phone:509-237-9753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-12
Last Update Date:2013-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60303240101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health