Provider Demographics
NPI:1336633155
Name:CARR, DOLORES (EDD)
Entity Type:Individual
Prefix:DR
First Name:DOLORES
Middle Name:
Last Name:CARR
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1904 DELLWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-1222
Mailing Address - Country:US
Mailing Address - Phone:434-882-0477
Mailing Address - Fax:
Practice Address - Street 1:4317 JAMES MADISON HWY
Practice Address - Street 2:
Practice Address - City:GORDONSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22942-6204
Practice Address - Country:US
Practice Address - Phone:434-882-0477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-15
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAPGP-0659532251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)