Provider Demographics
NPI:1093103772
Name:BOLIVAR, CHARDAY MARIE (LPCA)
Entity Type:Individual
Prefix:MRS
First Name:CHARDAY
Middle Name:MARIE
Last Name:BOLIVAR
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5884 FARINGDON PL STE 200
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-3932
Mailing Address - Country:US
Mailing Address - Phone:919-239-4041
Mailing Address - Fax:919-239-4280
Practice Address - Street 1:5884 FARINGDON PL STE 200
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-3932
Practice Address - Country:US
Practice Address - Phone:919-239-4041
Practice Address - Fax:919-239-4280
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-23856101YA0400X
NCA13002101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)