Individual
MR. MARIO BOLIVAR JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
112 CREEKSIDE DR, DALLAS, GA 30157-7370
(678) 237-1269
Mailing address
112 CREEKSIDE DR, DALLAS, GA 30157-7370
(678) 237-1269
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
1214
OR
1041C0700X
Clinical Social Worker
Primary
3071
FL
Other
Enumeration date
05/15/2009
Last updated
05/15/2009
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