Provider Demographics
NPI:1891827085
Name:BOBOLIA, MICHAEL P
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:P
Last Name:BOBOLIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 SHORE RD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28570-6083
Mailing Address - Country:US
Mailing Address - Phone:252-269-9411
Mailing Address - Fax:
Practice Address - Street 1:209 SHORE RD
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:NC
Practice Address - Zip Code:28570-6083
Practice Address - Country:US
Practice Address - Phone:252-269-9411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1213101YP2500X
NC7385101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional