Provider Demographics
NPI:1912781543
Name:BOLIN, MARY CHANDLER (LIC PSYCHOLOGIST)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:CHANDLER
Last Name:BOLIN
Suffix:
Gender:F
Credentials:LIC PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 E BELL CT
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40508-1934
Mailing Address - Country:US
Mailing Address - Phone:859-608-0171
Mailing Address - Fax:
Practice Address - Street 1:209 E BELL CT
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40508-1934
Practice Address - Country:US
Practice Address - Phone:859-608-0171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY129091103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling