Provider Demographics
NPI:1851649040
Name:BOLES, DARALICE D (MS, LPC)
Entity Type:Individual
Prefix:MS
First Name:DARALICE
Middle Name:D
Last Name:BOLES
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:731 N DUKE ST
Mailing Address - Street 2:1ST FLOOR SUITE
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-2019
Mailing Address - Country:US
Mailing Address - Phone:717-371-8427
Mailing Address - Fax:
Practice Address - Street 1:731 N DUKE ST
Practice Address - Street 2:1ST FLOOR SUITE
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-2019
Practice Address - Country:US
Practice Address - Phone:717-371-8427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-21
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC006432101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional