Healthcare Provider Details

I. General information

NPI: 1053903237
Provider Name (Legal Business Name): MALIKA BOLA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2021
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 BLOOMFIELD AVE
CALDWELL NJ
07006-5164
US

IV. Provider business mailing address

6 TULIP DR APT 3C
FORDS NJ
08863-1138
US

V. Phone/Fax

Practice location:
  • Phone: 973-259-6673
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: