MEDICARE: AMANDA BOLING

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	103K00000X	Behavior Analyst	1-22-63273	NC
2	222Q00000X	Developmental Therapist
3	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1851770176
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA BOLING

Provider Business Mailing Address
First Line	:	375 SE BROAD ST STE A
Second Line	:
City	:	SOUTHERN PINES
State	:	NC
Zip	:	28387-6000
Country	:	US
Telephone Number	:	910-537-2324
Fax Number	:

Provider Business Practice Location Address
First Line	:	1441 E BROAD ST # 90
Second Line	:
City	:	FUQUAY VARINA
State	:	NC
Zip	:	27526-1968
Country	:	US
Telephone Number	:	855-832-6727
Fax Number	:

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

Provider Enumeration Date	:	05/19/2015
Last Update Date	:	09/30/2025

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Directions to “ AMANDA BOLING ” Practice Location

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