Provider Demographics
NPI:1255867305
Name:DOLAN, DAVID J (LCADC, LPC,CSAC,LMHC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:J
Last Name:DOLAN
Suffix:
Gender:M
Credentials:LCADC, LPC,CSAC,LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1043 MAKAWAO AVE STE 209B
Mailing Address - Street 2:
Mailing Address - City:MAKAWAO
Mailing Address - State:HI
Mailing Address - Zip Code:96768-9468
Mailing Address - Country:US
Mailing Address - Phone:732-618-6830
Mailing Address - Fax:
Practice Address - Street 1:1043 MAKAWAO AVE STE 209B
Practice Address - Street 2:
Practice Address - City:MAKAWAO
Practice Address - State:HI
Practice Address - Zip Code:96768
Practice Address - Country:US
Practice Address - Phone:808-379-3766
Practice Address - Fax:808-379-3766
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00252000101YA0400X
HI1959-17R101YA0400X
NJ37PC00612100101YP2500X
HIMHC-494101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
1649798125OtherBODHI WELLNESS AND PSYCHOTHERAPY
1760990014OtherBODHI WELLNESS AND PSYCHOTHERAPY