Provider Demographics
NPI:1730927344
Name:DAHLBY, KINDAL HOLLY (LPC, MA)
Entity type:Individual
Prefix:
First Name:KINDAL
Middle Name:HOLLY
Last Name:DAHLBY
Suffix:
Gender:F
Credentials:LPC, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11391 ANDERSON HWY
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:VA
Mailing Address - Zip Code:24553-3355
Mailing Address - Country:US
Mailing Address - Phone:515-419-8427
Mailing Address - Fax:
Practice Address - Street 1:316 BROOK PARK PL
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:VA
Practice Address - Zip Code:24551-2766
Practice Address - Country:US
Practice Address - Phone:434-533-1088
Practice Address - Fax:434-616-2999
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701013780101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional