Provider Demographics
NPI:1619744232
Name:BOLIN, KATHERINE JULIA (MA)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:JULIA
Last Name:BOLIN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:KATHERINE
Other - Middle Name:JULIA
Other - Last Name:LYNCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:N/A
Mailing Address - Street 1:11250 ROGER BACON DR BLDG 153
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-5219
Mailing Address - Country:US
Mailing Address - Phone:571-455-5206
Mailing Address - Fax:703-636-8983
Practice Address - Street 1:11250 ROGER BACON DR BLDG 153
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5219
Practice Address - Country:US
Practice Address - Phone:571-455-5206
Practice Address - Fax:703-636-8983
Is Sole Proprietor?:No
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health