Provider Demographics
NPI:1750032744
Name:DOLAN, KATHLEEN (LCPC)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:DOLAN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2750 THORNBROOK RD
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-7804
Mailing Address - Country:US
Mailing Address - Phone:443-745-3115
Mailing Address - Fax:
Practice Address - Street 1:2750 THORNBROOK RD
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-7804
Practice Address - Country:US
Practice Address - Phone:443-745-3115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-12
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC1481101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional