Provider Demographics
NPI:1629427307
Name:BOLLING, KEIRYAN ASHLEIGH (LCSW-C)
Entity Type:Individual
Prefix:MS
First Name:KEIRYAN
Middle Name:ASHLEIGH
Last Name:BOLLING
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6030 MARSHALEE DR STE 712
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-6086
Mailing Address - Country:US
Mailing Address - Phone:443-328-3088
Mailing Address - Fax:
Practice Address - Street 1:6170 HUNT CLUB RD
Practice Address - Street 2:
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-5518
Practice Address - Country:US
Practice Address - Phone:443-328-3088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-03
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21778104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker