Provider Demographics
NPI:1164796447
Name:BOLLING, ANISA LASHAWN
Entity Type:Individual
Prefix:MISS
First Name:ANISA
Middle Name:LASHAWN
Last Name:BOLLING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4127 NEIGHBORLY CT
Mailing Address - Street 2:
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-6109
Mailing Address - Country:US
Mailing Address - Phone:702-302-3430
Mailing Address - Fax:
Practice Address - Street 1:4127 NEIGHBORLY CT
Practice Address - Street 2:
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-6109
Practice Address - Country:US
Practice Address - Phone:702-302-3430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-03
Last Update Date:2012-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health