MEDICARE: DR. LIGIA LATIFF-BOLET PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	001965	GA

General Provider Information

NPI Number	:	1366439903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LIGIA LATIFF-BOLET PH.D.

Provider Business Mailing Address
First Line	:	112 HILL LAKE DR
Second Line	:
City	:	LEXINGTON
State	:	SC
Zip	:	29072-9680
Country	:	US
Telephone Number	:	803-808-5667
Fax Number	:

Provider Business Practice Location Address
First Line	:	2414 BULL ST
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29201-1906
Country	:	US
Telephone Number	:	803-898-8619
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2005
Last Update Date	:	07/08/2007

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