Individual provider Active NPI

Kindal Holly Dahlby, LPC, MA

  • Professional Counselor
  • Forest, VA
National Provider Identifier
1730927344
Registry record updated Jul 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
0701013780 Issued in VA
Practice address
316 Brook Park PL
Forest, VA 24551-2766
Phone
(434) 533-1088
Fax
(434) 616-2999
NPI assigned
Jul 17, 2024
Last updated
Jul 17, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 17, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 0701013780 VA Primary

Addresses

Primary practice location

316 Brook Park PL
Forest, VA 24551-2766

Mailing address

11391 Anderson Hwy
Gladstone, VA 24553-3355
Phone (515) 419-8427

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
0701013780VAMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Impact Living Services Professional CurrentSince Jul 21, 2024 Accepting new patients

Locations

316 Brook Park Pl
Forest, VA 24551
Phone (434) 515-0877

316 Brook Park Pl
Ste A1
Forest, VA 24551
Phone (434) 533-1088

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1721174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721174400000",
    "number": "1730927344",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11391 ANDERSON HWY",
            "city": "GLADSTONE",
            "state": "VA",
            "postal_code": "245533355",
            "telephone_number": "515-419-8427"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "316 BROOK PARK PL",
            "city": "FOREST",
            "state": "VA",
            "postal_code": "245512766",
            "telephone_number": "434-533-1088",
            "fax_number": "434-616-2999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAHLBY",
        "first_name": "KINDAL",
        "middle_name": "HOLLY",
        "credential": "LPC, MA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-07-17",
        "last_updated": "2024-07-17",
        "certification_date": "2024-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "VA",
            "license": "0701013780",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Forest, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.