Provider Demographics
NPI:1255166831
Name:BOLYARD-DOUGLAS, SHEL M (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:SHEL
Middle Name:M
Last Name:BOLYARD-DOUGLAS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17316 WATERLOO RD
Mailing Address - Street 2:
Mailing Address - City:AMISSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20106-2059
Mailing Address - Country:US
Mailing Address - Phone:804-479-5033
Mailing Address - Fax:
Practice Address - Street 1:RRCSB DBA ENCOMPASS COMMUNITY SUPPORTS
Practice Address - Street 2:CULPEPER BEHAVIORAL HEALTHCARE, 16240 BENNETT ROAD
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701
Practice Address - Country:US
Practice Address - Phone:540-825-5656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA9040020811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical