Provider Demographics
NPI:1942226311
Name:LINDBLOM, DOLORES A (MSW)
Entity Type:Individual
Prefix:MRS
First Name:DOLORES
Middle Name:A
Last Name:LINDBLOM
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 STAFFORD AVE
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-5346
Mailing Address - Country:US
Mailing Address - Phone:540-370-4468
Mailing Address - Fax:540-370-4048
Practice Address - Street 1:130 EXECUTIVE CENTER PKWY
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-3100
Practice Address - Country:US
Practice Address - Phone:540-370-4468
Practice Address - Fax:540-370-4048
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC50078022101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health