Provider Demographics
NPI:1174075758
Name:FAIR, DOLORES K (MA, LPC)
Entity type:Individual
Prefix:
First Name:DOLORES
Middle Name:K
Last Name:FAIR
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2030 E BROADWAY BLVD
Mailing Address - Street 2:SUITE NUMBER #102
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-5905
Mailing Address - Country:US
Mailing Address - Phone:520-977-5030
Mailing Address - Fax:
Practice Address - Street 1:2030 E BROADWAY BLVD
Practice Address - Street 2:SUITE NUMBER #102
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-5905
Practice Address - Country:US
Practice Address - Phone:520-977-5030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-28
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC 15984101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health