Provider Demographics
NPI:1780647941
Name:BOLING, CHRIS (LCSW)
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:
Last Name:BOLING
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2111 W PINHOOK RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-1504
Mailing Address - Country:US
Mailing Address - Phone:337-349-1767
Mailing Address - Fax:337-214-0124
Practice Address - Street 1:2111 W PINHOOK RD
Practice Address - Street 2:SUITE B
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-1504
Practice Address - Country:US
Practice Address - Phone:337-349-1767
Practice Address - Fax:337-214-0124
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA108361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2133772Medicaid