1033259452 NPI number — MRS. DONNA BOLICK LAIL LCSW

Table of content: MRS. DONNA BOLICK LAIL LCSW (NPI 1033259452)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033259452 NPI number — MRS. DONNA BOLICK LAIL LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAIL
Provider First Name:
DONNA
Provider Middle Name:
BOLICK
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033259452
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 338
Provider Second Line Business Mailing Address:
204 IDOL DRIVE
Provider Business Mailing Address City Name:
THOMASVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27361-0338
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-474-1238
Provider Business Mailing Address Fax Number:
336-472-4605

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4475 UNION BAPTIST RD
Provider Second Line Business Practice Location Address:
1120 TAYLORSVILLE RD.
Provider Business Practice Location Address City Name:
LENOIR
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28645-9284
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-757-0700
Provider Business Practice Location Address Fax Number:
828-757-0721
Provider Enumeration Date:
02/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  C002116 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 101YP2500X , with the licence number: C002116 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6106083 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com