Healthcare Provider Details

I. General information

NPI: 1275837007
Provider Name (Legal Business Name): KARA B BOLLING LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KARA FALCK LCSW-C

II. Dates (important events)

Enumeration Date: 01/09/2011
Last Update Date: 02/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 SULGRAVE AVE SUITE 209
BALTIMORE MD
21209
US

IV. Provider business mailing address

1501 SULGRAVE AVE SUITE 209
BALTIMORE MD
21209
US

V. Phone/Fax

Practice location:
  • Phone: 240-377-0753
  • Fax: 301-309-2596
Mailing address:
  • Phone: 240-377-0753
  • Fax: 301-309-2596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number15002
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC50078650
License Number StateDC
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: