Provider Demographics
NPI:1003628280
Name:BOLIS, CHRISTINA (LPC)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:BOLIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1216 N CAMPBELL AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-2936
Mailing Address - Country:US
Mailing Address - Phone:312-890-1555
Mailing Address - Fax:
Practice Address - Street 1:1216 N CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-2936
Practice Address - Country:US
Practice Address - Phone:312-890-1555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL17802817101YP2500X
IL178020817101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional