Provider Demographics
NPI:1629220660
Name:DOLAN, LISA DAWN HICKS (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:DAWN HICKS
Last Name:DOLAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 PARK HILL DRIVE
Mailing Address - Street 2:INTEGRATED HEALTH, PC
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401
Mailing Address - Country:US
Mailing Address - Phone:540-371-8250
Mailing Address - Fax:540-371-0705
Practice Address - Street 1:421 PARK HILL DRIVE
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401
Practice Address - Country:US
Practice Address - Phone:540-371-8250
Practice Address - Fax:540-371-0705
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-22
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA094005782104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker