Healthcare Provider Details

I. General information

NPI: 1558174540
Provider Name (Legal Business Name): SAMANTHA N DOLAN BA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2025
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5004 ELK RIVER RD
ELKVIEW WV
25071
US

IV. Provider business mailing address

3206 3RD AVE
CHARLESTON WV
25387-2243
US

V. Phone/Fax

Practice location:
  • Phone: 304-759-9835
  • Fax:
Mailing address:
  • Phone: 304-982-9717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1235437138
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: