Provider Demographics
NPI:1164067310
Name:BOLLING BEHAVIORAL CONSULTING
Entity Type:Organization
Organization Name:BOLLING BEHAVIORAL CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-804-7235
Mailing Address - Street 1:2766 DA VINCI BLVD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-3116
Mailing Address - Country:US
Mailing Address - Phone:404-804-7235
Mailing Address - Fax:
Practice Address - Street 1:2766 DA VINCI BLVD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-3116
Practice Address - Country:US
Practice Address - Phone:404-804-7235
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-12
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty