Provider Demographics
NPI:1578768693
Name:DOLLINGER, ALICE (MFT)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:DOLLINGER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4949 GENESTA AVE
Mailing Address - Street 2:206
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-3401
Mailing Address - Country:US
Mailing Address - Phone:818-990-3009
Mailing Address - Fax:818-990-3334
Practice Address - Street 1:17000 VENTURA BLVD
Practice Address - Street 2:203
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-4109
Practice Address - Country:US
Practice Address - Phone:818-990-3009
Practice Address - Fax:818-990-3334
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC30340106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist