Provider Demographics
NPI:1922613108
Name:BOLAND, COLIN (BFA)
Entity Type:Individual
Prefix:
First Name:COLIN
Middle Name:
Last Name:BOLAND
Suffix:
Gender:M
Credentials:BFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 N WOLF RD
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-2922
Mailing Address - Country:US
Mailing Address - Phone:847-353-1500
Mailing Address - Fax:847-465-1964
Practice Address - Street 1:1111 W LAKE COOK RD
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-1926
Practice Address - Country:US
Practice Address - Phone:847-353-1758
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor