Provider Demographics
NPI:1053500108
Name:BOLLY, JOY ROSAMOND (LPC)
Entity Type:Individual
Prefix:MS
First Name:JOY
Middle Name:ROSAMOND
Last Name:BOLLY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31522 VILLA TER
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29707-6349
Mailing Address - Country:US
Mailing Address - Phone:704-877-9614
Mailing Address - Fax:
Practice Address - Street 1:1216 N TRYON ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28206-3256
Practice Address - Country:US
Practice Address - Phone:704-336-8679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-15
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5549101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional