Provider Demographics
NPI:1457567604
Name:PAULSON, DOLORES S (DSW)
Entity Type:Individual
Prefix:
First Name:DOLORES
Middle Name:S
Last Name:PAULSON
Suffix:
Gender:F
Credentials:DSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7643 LEESBURG PIKE
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22043-2530
Mailing Address - Country:US
Mailing Address - Phone:703-790-0786
Mailing Address - Fax:703-790-9257
Practice Address - Street 1:7643 LEESBURG PIKE
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22043-2530
Practice Address - Country:US
Practice Address - Phone:703-790-0786
Practice Address - Fax:703-790-9257
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040001611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC641459A60Medicare ID - Type Unspecified