Provider Demographics
NPI:1295953164
Name:BOLLING, AMANDA WELTMAN (MFT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:WELTMAN
Last Name:BOLLING
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:WELTMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT
Mailing Address - Street 1:PO BOX 747
Mailing Address - Street 2:
Mailing Address - City:GLEN ELLEN
Mailing Address - State:CA
Mailing Address - Zip Code:95442
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1421 GUERNVILLE
Practice Address - Street 2:SUITE 114
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403
Practice Address - Country:US
Practice Address - Phone:707-542-8979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC39434106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist