Provider Demographics
NPI:1891433462
Name:BOEHLING, MARIE A
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:A
Last Name:BOEHLING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5920 KENSINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-2636
Mailing Address - Country:US
Mailing Address - Phone:804-241-5124
Mailing Address - Fax:
Practice Address - Street 1:60 SCHOOL RD
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:VA
Practice Address - Zip Code:23040-2538
Practice Address - Country:US
Practice Address - Phone:804-492-4212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0803000286103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist