Provider Demographics
NPI:1922163609
Name:BOLICH, ILONA C (LCMHC)
Entity Type:Individual
Prefix:MS
First Name:ILONA
Middle Name:C
Last Name:BOLICH
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:ILONA
Other - Middle Name:C
Other - Last Name:PARIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:87 C STREET
Mailing Address - Street 2:FL 1
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03102
Mailing Address - Country:US
Mailing Address - Phone:857-413-7512
Mailing Address - Fax:
Practice Address - Street 1:87 C ST
Practice Address - Street 2:1ST FL
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03102-4704
Practice Address - Country:US
Practice Address - Phone:857-413-7512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-24
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5120101YM0800X
NH1157101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health