Healthcare Provider Details

I. General information

NPI: 1992254684
Provider Name (Legal Business Name): ERIN BOLLES LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2016
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4705A OLD POST RD
CHARLESTOWN RI
02813-2591
US

IV. Provider business mailing address

53 STERN ST
JAMESTOWN RI
02835-2671
US

V. Phone/Fax

Practice location:
  • Phone: 401-364-7705
  • Fax:
Mailing address:
  • Phone: 401-239-9437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC01078
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: