Provider Demographics
NPI:1326186750
Name:BOLINGER, DAVINA MAE (BA)
Entity Type:Individual
Prefix:MS
First Name:DAVINA
Middle Name:MAE
Last Name:BOLINGER
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1312 CARMICHAEL ST
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37814-2908
Mailing Address - Country:US
Mailing Address - Phone:423-581-7857
Mailing Address - Fax:
Practice Address - Street 1:225 W 1ST NORTH ST
Practice Address - Street 2:SUITE 302
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-4614
Practice Address - Country:US
Practice Address - Phone:423-522-2200
Practice Address - Fax:423-522-2180
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health