Provider Demographics
NPI:1558804997
Name:BOLIN, MAEGAN R S (LMHC, CDP)
Entity Type:Individual
Prefix:MRS
First Name:MAEGAN
Middle Name:R S
Last Name:BOLIN
Suffix:
Gender:F
Credentials:LMHC, CDP
Other - Prefix:MS
Other - First Name:MAEGAN
Other - Middle Name:R
Other - Last Name:SKOREPA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC, SUDP
Mailing Address - Street 1:PO BOX 2429
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-8486
Mailing Address - Country:US
Mailing Address - Phone:360-353-9494
Mailing Address - Fax:360-353-9440
Practice Address - Street 1:922 FIR ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2525
Practice Address - Country:US
Practice Address - Phone:360-353-9422
Practice Address - Fax:360-353-9440
Is Sole Proprietor?:No
Enumeration Date:2016-12-01
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT-17-179101YA0400X
WACO60901400101YA0400X
OR17-07-15101YA0400X
WACP60996825101YA0400X
101YM0800X, 390200000X
WAMC60901399101YM0800X
WALH60937291101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500733467Medicaid
OR500718645Medicaid