Individual
ALISIA MICHELLE BOLIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
851 N WILSON ST, CRESTVIEW, FL 32536-2639
(850) 398-6021
Mailing address
3771 STEFANI RD, CANTONMENT, FL 32533-7795
(850) 398-6021
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-18-53062
FL
Other
Enumeration date
04/09/2018
Last updated
04/09/2018
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