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General NPI Number Information
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NPI Number | 1639728181
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Entity Type | Individual
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Provider Name | ALICA N BOLEWARE M.A.
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Gender | Female
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Dates
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Enumeration Date | 09/07/2019
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 2 W LAFAYETTE ST # 104
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City | NORRISTOWN
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State | PA
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Zip | 19401-4758
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Country | US
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Telephone | 610-755-9485
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Fax |
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Provider Business Mailing Address
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Address Line | 3857 PECHIN ST UNIT 104
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City | PHILADELPHIA
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State | PA
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Zip | 19128-3642
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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