Provider Demographics
NPI:1770091696
Name:DOLPHIN, JENNIFER D (LPC)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:D
Last Name:DOLPHIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12355 DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-3436
Mailing Address - Country:US
Mailing Address - Phone:907-865-8452
Mailing Address - Fax:907-802-6486
Practice Address - Street 1:12355 DIVISION ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-3436
Practice Address - Country:US
Practice Address - Phone:907-350-8646
Practice Address - Fax:907-729-5268
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-12
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK125634101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor