Provider Demographics
NPI:1386865079
Name:DULKEN, JOHN GLENN (LPC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:GLENN
Last Name:DULKEN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3610 SULKIRK RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-6242
Mailing Address - Country:US
Mailing Address - Phone:704-552-5252
Mailing Address - Fax:704-552-9434
Practice Address - Street 1:3610 SULKIRK RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-6242
Practice Address - Country:US
Practice Address - Phone:704-552-5252
Practice Address - Fax:704-552-9434
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2743101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional