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General NPI Number Information
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NPI Number | 1720506801
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Entity Type | Individual
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Provider Name | IAN JAMES BOLLAND MS, LGPC, NCC
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Gender | Male
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Dates
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Enumeration Date | 09/08/2017
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Last Update Date | 03/25/2024
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Provider Practice Location Address
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Address Line | 3410 WHITE AVE
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City | BALTIMORE
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State | MD
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Zip | 21214-2301
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Country | US
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Telephone | 410-522-3746
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Fax |
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Provider Business Mailing Address
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Address Line | 53 WANOMA CIR
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City | REHOBOTH BEACH
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State | DE
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Zip | 19971-7704
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Country | US
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Telephone | 201-602-9587
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LGP7854
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LC9569
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License Number State | MD
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