Healthcare Provider Details

I. General information

NPI: 1972537603
Provider Name (Legal Business Name): JANET UPDYKE BOLAND PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HARBISON WAY SUITE 110
COLUMBIA SC
29212
US

IV. Provider business mailing address

1 HARBISON WAY SUITE 110
COLUMBIA SC
29212
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 TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number423
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: