=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730992439
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADOLAN, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/28/2025
-----------------------------------------------------
Last Update Date | 01/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 408 E. RAILWAY
-----------------------------------------------------
City | COLEMAN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48618
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-465-7240
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 408 W WEBSTER ST
-----------------------------------------------------
City | COLEMAN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48618-9700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-859-8577
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL SOCIAL WORKER
-----------------------------------------------------
Name | AMANDA J DOLAN
-----------------------------------------------------
Credential | LMSW
-----------------------------------------------------
Telephone | 989-859-8577
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------