Provider Demographics
NPI:1639717820
Name:DOLPHUS, NANNETTE
Entity Type:Individual
Prefix:MS
First Name:NANNETTE
Middle Name:
Last Name:DOLPHUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5811 ANKENY CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-2346
Mailing Address - Country:US
Mailing Address - Phone:704-493-8060
Mailing Address - Fax:
Practice Address - Street 1:5811 ANKENY CT
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-2346
Practice Address - Country:US
Practice Address - Phone:704-493-8060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-18
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health