Healthcare Provider Details

I. General information

NPI: 1720506801
Provider Name (Legal Business Name): IAN JAMES BOLLAND MS, LGPC, NCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2017
Last Update Date: 03/25/2024
Certification Date: 03/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3410 WHITE AVE
BALTIMORE MD
21214-2301
US

IV. Provider business mailing address

53 WANOMA CIR
REHOBOTH BEACH DE
19971-7704
US

V. Phone/Fax

Practice location:
  • Phone: 410-522-3746
  • Fax:
Mailing address:
  • Phone: 201-602-9587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC9569
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLGP7854
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: