Provider Demographics
NPI:1821696717
Name:BOLZ OKSEN, TESSA JANE (LCMHC)
Entity Type:Individual
Prefix:
First Name:TESSA
Middle Name:JANE
Last Name:BOLZ OKSEN
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 E RENOVAH CIR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-1228
Mailing Address - Country:US
Mailing Address - Phone:585-489-9533
Mailing Address - Fax:
Practice Address - Street 1:202 S 5TH AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-5494
Practice Address - Country:US
Practice Address - Phone:585-489-9533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-13
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16044101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health