Provider Demographics
NPI:1255794517
Name:DOLAN, KIMBERLY (LMHC, LAC, NCC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:DOLAN
Suffix:
Gender:F
Credentials:LMHC, LAC, NCC
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:808-379-3766
Mailing Address - Fax:808-379-3766
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:2016-04-03
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00303600101YM0800X
HIMHC-512101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1649798125OtherBODHI WELLNESS AND PSYCHOTHERAPY
HI1760990014OtherBODHI WELLNESS AND PSYCHOTHERAPY