Provider Demographics
NPI:1851609705
Name:BOLLING, KIM (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:
Last Name:BOLLING
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 BROAD ST STE 1527
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03063-3205
Mailing Address - Country:US
Mailing Address - Phone:603-400-6160
Mailing Address - Fax:603-324-7450
Practice Address - Street 1:154 BROAD ST STE 1527
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03063-3205
Practice Address - Country:US
Practice Address - Phone:603-400-6160
Practice Address - Fax:603-324-7450
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-14
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1367103TC0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3114379Medicaid