Individual
MS. SHANNON L BOLEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW
Contact information
Practice address
204 WEST HILL BLVD., 437TH MEDICAL GROUP/SGOH, CHARLESTON AFB, SC 29404-4704
(843) 963-6972
(843) 963-6930
Mailing address
204 WEST HILL BLVD, 437TH MEDICAL GROUP/SGOH, CHARLESTON AFB, SC 29404-4704
(843) 963-6972
(843) 963-6930
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
20642
CA
Other
Enumeration date
08/09/2007
Last updated
09/13/2007
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