Provider Demographics
NPI:1144282245
Name:DOLAN, CAROLYN G (LPC)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:G
Last Name:DOLAN
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 1:9228 GEORGE WASHINGTON MEMORIAL HWY
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23061-4162
Mailing Address - Country:US
Mailing Address - Phone:804-693-5057
Mailing Address - Fax:804-693-7407
Practice Address - Street 1:9228 GEORGE WASHINGTON MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:VA
Practice Address - Zip Code:23061-4162
Practice Address - Country:US
Practice Address - Phone:804-693-5057
Practice Address - Fax:804-693-7407
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701001479101YP2500X
VA0717000483106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA061740OtherVALUE OPTIONS
VA250220Medicaid
VA5979283OtherAETNA
VAO86401Medicaid
VA1290-2737OtherUNITED BEHAVIORAL HEALTH
VA331726OtherTRICARE
VA250220OtherHEALTHKEEPERS
VA250220OtherANTHEM
VA2049251OtherCIGNA
VAO86401OtherSOUTHERN HEALTH