Provider Demographics
NPI:1720506801
Name:BOLLAND, IAN JAMES (MS, LGPC, NCC)
Entity Type:Individual
Prefix:MR
First Name:IAN
Middle Name:JAMES
Last Name:BOLLAND
Suffix:
Gender:M
Credentials:MS, LGPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 WANOMA CIR
Mailing Address - Street 2:
Mailing Address - City:REHOBOTH BEACH
Mailing Address - State:DE
Mailing Address - Zip Code:19971-7704
Mailing Address - Country:US
Mailing Address - Phone:201-602-9587
Mailing Address - Fax:
Practice Address - Street 1:3410 WHITE AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21214-2301
Practice Address - Country:US
Practice Address - Phone:410-522-3746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-08
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP7854101YP2500X
MDLC9569101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDLC9569OtherMD STATE