Individual
MARY ANGELA BOLAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCP
Contact information
Practice address
1657 MERRIMAC TRL, WILLIAMSBURG, VA 23185-5624
(757) 220-3200
(757) 253-4371
Mailing address
1657 MERRIMAC TRL, WILLIAMSBURG, VA 23185-5624
(757) 220-3200
(757) 253-4371
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
0810003602
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
189775
ANTHEM
VA
05
—
189775
—
VA
01
—
294721
VALUE OPTIONS
VA
01
—
O88011M
SOUTHERN HEALTH
VA
05
—
O88011M
—
VA
Enumeration date
04/05/2006
Last updated
07/09/2007
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