MEDICARE: MS. JOY ROSAMOND BOLLY LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	5549	NC

General Provider Information

NPI Number	:	1053500108
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JOY ROSAMOND BOLLY LPC

Provider Business Mailing Address
First Line	:	31522 VILLA TER
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29707-6349
Country	:	US
Telephone Number	:	704-877-9614
Fax Number	:

Provider Business Practice Location Address
First Line	:	1216 N TRYON ST
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28206-3256
Country	:	US
Telephone Number	:	704-336-8679
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/15/2007
Last Update Date	:	10/15/2007

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