Provider Demographics
NPI:1982324828
Name:KOLAS, THEONI (MA)
Entity Type:Individual
Prefix:
First Name:THEONI
Middle Name:
Last Name:KOLAS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 HOWE TER APT 3
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02125-2172
Mailing Address - Country:US
Mailing Address - Phone:507-226-6823
Mailing Address - Fax:
Practice Address - Street 1:140B SOUTH ST
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-3816
Practice Address - Country:US
Practice Address - Phone:617-884-4357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-31
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health