Organization
JOHN P BOLGER PHD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN P BOLGER PH.D. (SOLE OWNER)
(910) 987-7285
Entity
Organization
Contact information
Practice address
1305 WILD OLIVE DR, MT PLEASANT, SC 29464-7478
(910) 987-7285
Mailing address
1305 WILD OLIVE DR, MT PLEASANT, SC 29464-7478
(910) 987-7285
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
1237
SC
103TA0700X
Adult Development & Aging Psychologist
1237
SC
103TC0700X
Clinical Psychologist
1237
SC
103TH0004X
Health Psychologist
1237
SC
Other
Enumeration date
06/20/2015
Last updated
06/20/2015
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