Provider Demographics
NPI:1902164718
Name:WASSON, DOLLYEANNA BARBER
Entity Type:Individual
Prefix:MS
First Name:DOLLYEANNA
Middle Name:BARBER
Last Name:WASSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:DOLLYEANNA
Other - Middle Name:
Other - Last Name:BARBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED
Mailing Address - Street 1:130 KUAILIMA DR
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-3221
Mailing Address - Country:US
Mailing Address - Phone:808-389-5592
Mailing Address - Fax:
Practice Address - Street 1:130 KUAILIMA DR
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-3221
Practice Address - Country:US
Practice Address - Phone:808-389-5592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-30
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional