Provider Demographics
NPI:1558864322
Name:BOLLING, AUDREY MARIE (MSCC)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:MARIE
Last Name:BOLLING
Suffix:
Gender:F
Credentials:MSCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WYNMERE DR
Mailing Address - Street 2:
Mailing Address - City:ERIAL
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-2214
Mailing Address - Country:US
Mailing Address - Phone:609-230-0768
Mailing Address - Fax:
Practice Address - Street 1:521 ERIAL RD
Practice Address - Street 2:
Practice Address - City:PINE HILL
Practice Address - State:NJ
Practice Address - Zip Code:08021-6301
Practice Address - Country:US
Practice Address - Phone:856-516-7052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-17
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00613200101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional