Individual
GAYNELLE BOLLING
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
102 MANDARIN DR, PIKEVILLE, NC 27863-0020
(919) 214-1911
Mailing address
102 MANDARIN DR, PIKEVILLE, NC 27863-0020
(919) 214-1911
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
85-1342554
INTERNAL REVENUE SERVICE
—
Enumeration date
06/08/2020
Last updated
06/08/2020
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