Provider Demographics
NPI:1225351802
Name:MICHAEL-BOLLINGER, LAVINIA A (BCBA-L)
Entity Type:Individual
Prefix:MRS
First Name:LAVINIA
Middle Name:A
Last Name:MICHAEL-BOLLINGER
Suffix:
Gender:F
Credentials:BCBA-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7583 VINCENT DR
Mailing Address - Street 2:
Mailing Address - City:TOANO
Mailing Address - State:VA
Mailing Address - Zip Code:23168-9042
Mailing Address - Country:US
Mailing Address - Phone:321-427-0149
Mailing Address - Fax:
Practice Address - Street 1:7583 VINCENT DR
Practice Address - Street 2:
Practice Address - City:TOANO
Practice Address - State:VA
Practice Address - Zip Code:23168
Practice Address - Country:US
Practice Address - Phone:321-427-0149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-10
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst