Provider Demographics
NPI:1881297133
Name:BOBOLA, EMILY (MS, LBA, BCBA)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:BOBOLA
Suffix:
Gender:F
Credentials:MS, LBA, BCBA
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:MAYLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LBA, BCBA
Mailing Address - Street 1:42014 VILLANOVA DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48313-2970
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11835 FISHING POINT DR STE 202
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-2585
Practice Address - Country:US
Practice Address - Phone:757-243-1033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-19
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7401001318103K00000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst