Provider Demographics
NPI:1801824701
Name:BOLAND, JOSEPH PATRICK (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:PATRICK
Last Name:BOLAND
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HARBISON WAY
Mailing Address - Street 2:SUITE 110
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29212-3422
Mailing Address - Country:US
Mailing Address - Phone:803-781-4265
Mailing Address - Fax:803-781-7300
Practice Address - Street 1:1 HARBISON WAY
Practice Address - Street 2:SUITE 110
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29212-3422
Practice Address - Country:US
Practice Address - Phone:803-781-4265
Practice Address - Fax:803-781-7300
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AD003091103TA0400X
SC442103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
457503000OtherMAGELLAN
177600OtherAPS HEALTHCARE
457503000OtherMAGELLAN