Individual
DAKOTA RENNE BOLIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1094 S FIRST ST NE, BROOKHAVEN, MS 39601-4762
(769) 233-7154
Mailing address
529 SCHMIDT RD NE, MEADVILLE, MS 39653-8379
(769) 244-7482
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-24-392822
MS
Other
Enumeration date
11/20/2024
Last updated
11/20/2024
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