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General NPI Number Information
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NPI Number | 1750635231
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Entity Type | Organization
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Legal Business Name | BOLLICH, LLC
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Dates
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Enumeration Date | 11/05/2012
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Last Update Date | 11/05/2012
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Provider Practice Location Address
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Address Line | 65 DUKE ST STE 111
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City | PRINCE FREDERICK
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State | MD
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Zip | 20678-6128
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Country | US
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Telephone | 301-448-9283
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1633
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City | PRINCE FREDERICK
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State | MD
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Zip | 20678-1633
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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 | NEUROPSYCHOLOGIST
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Name | DR. ANGELA MARIE BOLLICH
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Credential | PH.D.
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Telephone | 301-448-9283
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 04336
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License Number State | MD
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