Provider Demographics
NPI:1497179667
Name:DOLLE, KATRINA MARIE (LCSW, CADC)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:MARIE
Last Name:DOLLE
Suffix:
Gender:F
Credentials:LCSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2303 SUNNYDALE DR
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-1844
Mailing Address - Country:US
Mailing Address - Phone:630-395-9407
Mailing Address - Fax:
Practice Address - Street 1:2303 SUNNYDALE DR
Practice Address - Street 2:
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-1844
Practice Address - Country:US
Practice Address - Phone:630-395-9407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-09
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL20895101YA0400X
IL149.0141921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)