MEDICARE: MS. ELIZABETH ASHLEY DOLAN LCPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	LC8333	MD

General Provider Information

NPI Number	:	1659874139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELIZABETH ASHLEY DOLAN LCPC

Provider Business Mailing Address
First Line	:	521 S BRADFORD ST
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21224-3605
Country	:	US
Telephone Number	:	443-614-9080
Fax Number	:

Provider Business Practice Location Address
First Line	:	9256 BENDIX RD STE 200B
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21045-1848
Country	:	US
Telephone Number	:	443-542-0773
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/12/2018
Last Update Date	:	03/12/2018

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