Provider Demographics
NPI:1831218544
Name:DOVALIS, JOANNA N (MA PHD)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:N
Last Name:DOVALIS
Suffix:
Gender:F
Credentials:MA PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23181 LA CADENA DR
Mailing Address - Street 2:#103
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653
Mailing Address - Country:US
Mailing Address - Phone:949-380-8868
Mailing Address - Fax:949-380-3754
Practice Address - Street 1:23181 LA CADENA DR
Practice Address - Street 2:#103
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653
Practice Address - Country:US
Practice Address - Phone:949-380-8868
Practice Address - Fax:949-380-3754
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC29784106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist