Provider Demographics
NPI:1881169936
Name:DOBBINS, J MALE (LPC-IT, MS)
Entity type:Individual
Prefix:
First Name:J
Middle Name:MALE
Last Name:DOBBINS
Suffix:
Gender:M
Credentials:LPC-IT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1042 EAST AVE N
Mailing Address - Street 2:
Mailing Address - City:ONALASKA
Mailing Address - State:WI
Mailing Address - Zip Code:54650-2269
Mailing Address - Country:US
Mailing Address - Phone:608-385-1327
Mailing Address - Fax:
Practice Address - Street 1:115 5TH AVE S STE 523
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-4018
Practice Address - Country:US
Practice Address - Phone:608-797-5679
Practice Address - Fax:608-782-4426
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-04
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4171-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional