MEDICARE: KRISTEN DOLAN LPC, NCC

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	101YM0800X	Mental Health Counselor	37AC00448400	NJ
2	101YP2500X	Professional Counselor	37PC00852400	NJ
3	101YP2500X	Professional Counselor	8832	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851858153
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN DOLAN LPC, NCC

Provider Business Mailing Address
First Line	:	8 JOHNSTON AVE
Second Line	:
City	:	BRICK
State	:	NJ
Zip	:	08724-2312
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4975 LACROSS RD
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29406-6523
Country	:	US
Telephone Number	:	843-261-5949
Fax Number	:

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

Provider Enumeration Date	:	02/23/2019
Last Update Date	:	05/24/2023

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