Provider Demographics
NPI:1619512555
Name:SQUIRES, DOROTHY LYNN (MA, LPC)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:LYNN
Last Name:SQUIRES
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:DOROTHY
Other - Middle Name:LYNN
Other - Last Name:SQUIRES-WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3260 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-7808
Mailing Address - Country:US
Mailing Address - Phone:907-796-8985
Mailing Address - Fax:907-796-8497
Practice Address - Street 1:3260 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-7808
Practice Address - Country:US
Practice Address - Phone:907-798-8498
Practice Address - Fax:907-798-8497
Is Sole Proprietor?:No
Enumeration Date:2019-11-14
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKPCOP94101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional