Individual
MARY MAIIO BOLGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6801 DIXIE HWY STE 132, LOUISVILLE, KY 40258-3952
(502) 657-2701
(502) 536-7991
Mailing address
6801 DIXIE HWY STE 132, LOUISVILLE, KY 40258-3952
(502) 657-2701
(502) 536-7991
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LCAS-28380
NC
1041C0700X
Clinical Social Worker
Primary
LCS00001464
KY
1041C0700X
Clinical Social Worker
P018195
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P018195
LCSW-A
NC
Enumeration date
11/21/2022
Last updated
05/18/2026
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