Provider Demographics
NPI:1659434777
Name:DAULONG, LARRY W
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:W
Last Name:DAULONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2261 ELM ST
Mailing Address - Street 2:COUNTY OF NAPA HHSA, CFBH
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94559-3721
Mailing Address - Country:US
Mailing Address - Phone:707-259-8676
Mailing Address - Fax:707-259-8651
Practice Address - Street 1:2261 ELM ST
Practice Address - Street 2:COUNTY OF NAPA HHSA, CFBH
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94559-3721
Practice Address - Country:US
Practice Address - Phone:707-259-8676
Practice Address - Fax:707-259-8651
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health