Provider Demographics
NPI:1720261977
Name:BOLGER, DONNA
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:BOLGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13726 SOUTH OLD STATE ROAD
Mailing Address - Street 2:
Mailing Address - City:ELLENDALE
Mailing Address - State:DE
Mailing Address - Zip Code:19941
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13726 SOUTH OLD STATE ROAD
Practice Address - Street 2:
Practice Address - City:ELLENDALE
Practice Address - State:DE
Practice Address - Zip Code:19941
Practice Address - Country:US
Practice Address - Phone:302-422-2350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-11
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)