Provider Demographics
NPI:1295791077
Name:BOLICK, JEANNE LATIMER (LCSW)
Entity type:Individual
Prefix:MS
First Name:JEANNE
Middle Name:LATIMER
Last Name:BOLICK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 WINDROCK LN
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-9766
Mailing Address - Country:US
Mailing Address - Phone:919-854-0560
Mailing Address - Fax:
Practice Address - Street 1:1300 SE MAYNARD RD
Practice Address - Street 2:SUITE 103
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-3602
Practice Address - Country:US
Practice Address - Phone:919-380-0127
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0038881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical