Healthcare Provider Details

I. General information

NPI: 1952013666
Provider Name (Legal Business Name): KYLEE DOLIN LGSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2022
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 D ST
SOUTH CHARLESTON WV
25303-3104
US

IV. Provider business mailing address

218 D ST
SOUTH CHARLESTON WV
25303-3104
US

V. Phone/Fax

Practice location:
  • Phone: 304-720-3835
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberBP00946423
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: