Provider Demographics
NPI:1407029846
Name:DOLAN, DIANA C (PHD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:C
Last Name:DOLAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1916 TRILLIUM CV
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78733-5712
Mailing Address - Country:US
Mailing Address - Phone:940-206-9703
Mailing Address - Fax:
Practice Address - Street 1:1916 TRILLIUM CV
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78733-5712
Practice Address - Country:US
Practice Address - Phone:940-206-9703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-07
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1595103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral