Provider Demographics
NPI:1033259452
Name:LAIL, DONNA BOLICK (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:BOLICK
Last Name:LAIL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 338
Mailing Address - Street 2:204 IDOL DRIVE
Mailing Address - City:THOMASVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27361-0338
Mailing Address - Country:US
Mailing Address - Phone:336-474-1238
Mailing Address - Fax:336-472-4605
Practice Address - Street 1:4475 UNION BAPTIST RD
Practice Address - Street 2:1120 TAYLORSVILLE RD.
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-9284
Practice Address - Country:US
Practice Address - Phone:828-757-0700
Practice Address - Fax:828-757-0721
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC002116101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6106083Medicaid