Healthcare Provider Details

I. General information

NPI: 1801286901
Provider Name (Legal Business Name): AMANDA JAYNE DOLAN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2015
Last Update Date: 12/28/2024
Certification Date: 12/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S CRAPO ST STE 100
MT PLEASANT MI
48858-2941
US

IV. Provider business mailing address

408 W WEBSTER ST
COLEMAN MI
48618-9700
US

V. Phone/Fax

Practice location:
  • Phone: 989-772-5938
  • Fax: 989-773-1968
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6802088428
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801119543
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: