Provider Demographics
NPI:1316596547
Name:DOLLARD, JASON DOMENIC (MFT)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:DOMENIC
Last Name:DOLLARD
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:178 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-3014
Mailing Address - Country:US
Mailing Address - Phone:401-525-6111
Mailing Address - Fax:
Practice Address - Street 1:178 BROADWAY
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-3014
Practice Address - Country:US
Practice Address - Phone:401-525-6111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist