Basic Information
| Provider Information | |||||||||
| NPI: | 1275837007 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOLLING | ||||||||
| FirstName: | KARA | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW-C | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | FALCK | ||||||||
| OtherFirstName: | KARA | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | LCSW-C | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1501 SULGRAVE AVE | ||||||||
| Address2: | SUITE 209 | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2403770753 | ||||||||
| FaxNumber: | 3013092596 | ||||||||
| Practice Location | |||||||||
| Address1: | 1501 SULGRAVE AVE | ||||||||
| Address2: | SUITE 209 | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2403770753 | ||||||||
| FaxNumber: | 3013092596 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2011 | ||||||||
| LastUpdateDate: | 02/08/2017 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 15002 | MD | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | LC50078650 | DC | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | MD | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.