Provider Demographics
NPI:1932508116
Name:BOLANDER, CHANDA (LLMSW)
Entity Type:Individual
Prefix:
First Name:CHANDA
Middle Name:
Last Name:BOLANDER
Suffix:
Gender:M
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:463 E CIRCLE DR
Mailing Address - Street 2:RM 123
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-7505
Mailing Address - Country:US
Mailing Address - Phone:517-884-6553
Mailing Address - Fax:
Practice Address - Street 1:463 E CIRCLE DR
Practice Address - Street 2:RM 123
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48824-7505
Practice Address - Country:US
Practice Address - Phone:517-884-6553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010957311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical