Healthcare Provider Details

I. General information

NPI: 1801824701
Provider Name (Legal Business Name): JOSEPH PATRICK BOLAND PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 08/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HARBISON WAY SUITE 110
COLUMBIA SC
29212-3422
US

IV. Provider business mailing address

1 HARBISON WAY SUITE 110
COLUMBIA SC
29212-3422
US

V. Phone/Fax

Practice location:
  • Phone: 803-781-4265
  • Fax: 803-781-7300
Mailing address:
  • Phone: 803-781-4265
  • Fax: 803-781-7300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License NumberAD003091
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number442
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: